Forty years after the landmark Alma-Ata Declaration, gross inequities in health status across socio-economic classes remain apparent in the Philippines. The implementation of primary health care (PHC), dubbed as the key to achieving “health for all”, is deemed insufficient and uneven within the country making universal health coverage (UHC) far from reality.
On 25-26 October 2018, the world will once again convene at the Global Conference on Primary Health Care to express the intention to renew the commitment to the values and principles of the Alma-Ata Declaration and to succeed in achieving health for all. The draft Declaration of the Second International Conference on Primary Health Care reaffirms the commitment to the strengthening of primary health care worldwide and refocusing global efforts to achieve universal health coverage and the Sustainable Development Goals (SDGs).
During the past three decades, the Philippines underwent structural reforms and introduced key programs that took the country a step closer to meeting the Millennium Development Goals (MDGs) and achieving a fully reformed healthcare system that is equitable, inclusive, efficient, accessible, and responsive to the needs of the Filipino people. Despite these efforts, the Philippines still lagged behind in terms of achieving the MDGs. Inequities in health outcomes persist. Impoverishing healthcare costs accompanied by relatively poor quality of healthcare moved the country farther from realizing its national objectives for health.
House Bill No. 5784 (hereinafter referred to as HBN 5784 or UHC Bill or Bill), otherwise known as the “Universal Health Care Bill”, echoes the principles of the Alma-Ata Declaration and declares a policy that protects and promotes the “right to health of every Filipino”. The Bill, certified as urgent by President Rodrigo Duterte, is a manifestation of the State’s firm commitment to achieving health for all. The Bill is also in congruence with the draft declaration of the Second International Conference on Primary Health Care (hereinafter referred to as “draft declaration”).
Primary health care as key to achieving UHC and SDGs
The draft declaration stipulates that primary health care promises to improve health equity, coverage of services, cost-effectiveness, efficiency, and people’s experience of care. Moreover, it highlights the importance of reorienting the health system away from the “overemphasis on curative care, disease-specific programs, highly-specialized care services, and commercialization.”
HBN 5784 seeks to promote this by making it a policy of the State to (1) adopt an integrated and comprehensive approach to health development, and (2) to provide all Filipinos healthy living conditions and access to needed high quality preventive, curative, rehabilitative and palliative healthcare services without financial difficulty.
The same bill seeks to shift the engagement and contracting of health services from individual health provider (and facility) to service delivery networks (SDNs) of health providers and facilities encompassing primary to tertiary levels of care. This organizes health services in an integrated fashion which will make universal health coverage effective and sustainable.
Utilizing a whole-of-government, whole-of-society, and whole-of-system approach
The country continues to face a ton of unsolved health-related challenges – from the double burden of disease to rising inequities- stemming from a fragmented healthcare system, poor implementation of health and public policies, and poor citizen participation.
The draft declaration reiterates that achieving health for all is dependent upon the (1) involvement of the whole society in the development process, (2) an inclusive and intersectoral approach, and (3) a people-centered health system. Primary health care promotes intersectoral action which is essential to the attainment of interdependent goals, including the Sustainable Development Goals.
HBN 5784 seeks to strengthen the country’s health system through a “whole-of-government”, “whole-of-system”, and “whole-of-society” approach in health governance and in developing health-related policies. The said bill seeks to mandate the Department of Health (DOH) to develop intersectoral policies beneficial to health including urban planning, transport safety, air and water pollution control and prevention, crime prevention and control, among others. The DOH is also mandated to integrate national health programs into other existing government programs. Other government agencies such as the Department of Social Welfare and Development (DSWD), Department of Interior and Local Government (DILG) and local government units (LGU) assume other responsibilities and work together with the DOH in various capacities.
The draft declaration also encourages the people and the civil society to commit to “utilize, demand and advocate for high quality primary healthcare within a transformed health system.” This is supported by HBN 5784 by mandating the DOH and its attached agencies and healthcare facilities, in partnership with local government units (LGUs) and the private sector, to develop programs or campaigns aimed at increasing public awareness on the rights and benefits that the citizens are entitled to under health-related programs of the government. This could potentially improve health literacy and promote health seeking behavior and community involvement in health services.
To sustain primary health care and achieve universal health coverage and the sustainable development goals, national policies and strategies should be formulated to mobilize the country’s limited resources and to rationally use external funding and resources. The draft declaration emphasizes the importance of mobilizing domestic financing and better use of internal resources to ensure financial investment and financial protection in health, particularly in primary health care.
HBN 5784 seeks to improve financial protection by amending Republic Act No. 7875 which established the National Health Insurance Program which will provide health insurance coverage for all Filipino citizens. The Bill also mandates that every Filipino be automatically included in the National Health Security Program (currently the National Health Insurance Program) and is therefore entitled to all benefits prescribed to its members ensuring access to health services with the least financial risk or burden. The Program will primarily work through subsidizing healthcare costs of the poor and the sick by those who are considered healthy and have the ability to pay medical care.
Moreover, the Bill mandates the DOH and LGUs to finance all population-based entitlements while individual-based entitlements shall be purchased through the National Health Security Corporation (currently the National Health Insurance Corporation).
Other financing schemes include the combination of budget appropriations, contributions, earmarked funds, and other funds. The end goal of these amendments and financing schemes is to raise revenues for health which could help cover all Filipinos, especially the poor and marginalized, against heath-related financial risk.
Making the system work
Crucial to the achievement of universal health coverage and the Sustainable Development Goals is the efficient and effective implementation of a people-centered primary health care. The implementation of primary health care in the Philippines remains insufficient and uneven due to various factors including sound health policy.
HBN 5784 will serve as the State’s policy that provides the necessary framework for universal health coverage by adopting a whole-of-system, whole-of-government, and whole-of-society approach that considers all sectors and stakeholders in the planning, implementation, monitoring, and evaluation of all health-related policies, programs, and actions. True to the ideals and principles of the Alma-Ata Declaration and the draft declaration of the Second Global Conference on Primary Health Care, HBN 5784 could potentially improve the health care situation in the country by entitling every Filipino to healthy living conditions and access to a comprehensive set of high quality, effective and affordable health services that are promotive, preventive, curative, rehabilitative, and/or palliative in nature without suffering financial difficulty when obtaining such services. ###
Declaration of Alma-Ata International Conference on Primary Health Care, Alma-Ata, USSR, 6–12 September 1978. (2004). Development, 47(2), pp.159-161.
Draft Declaration of the Second International Conference on Primary Health Care. (2018). World Health Organization. Retrieved from http://www.who.int/primary-health/conference-phc/DRAFT-Declaration–9-April-2018.pdf on 23 August 2018
Universal Health Coverage Bill, House Bill No. 5784, Seventeenth Congress of the Philippines (2017)