Promote TACM to achieve UHC

More than twenty years after the enactment of the Traditional and Alternative Medicine Act (TAMA), the Philippines has not adequately expanded the credibility and integration of traditional, alternative, and complementary medicine (TACM), especially herbal medicine, into the country’s health system. In particular, the ten DOH-approved herbal plants in the Philippines have not received adequate attention they needed to penetrate Filipino households, especially those in low-resource settings.

In low-resource settings, especially in rural geographically isolated and disadvantaged areas (GIDA), there are usually fewer conventional health care practitioners than traditional practitioners. Some patients travel by foot for several hours to get to the nearest health facility. On the average, a Filipino household spends P4,000/year on medical care. Drugs account for almost 70% of total household out-of-pocket payments (OOP)1. OOP expenditures continue to grow despite the presence of alternative financing such as Philhealth. In extreme cases, high OOP expenditures can lead to poverty.

Integration of herbal medicine offers a path to achieve universal health care (UHC). This can contribute to meeting the immediate health needs of the people and improving access to care without suffering from financial hardship. Thus, promoting herbal medicine that is culturally-embedded in Filipino health-seeking behaviors is an important component of health care. Sometimes, it is the only available or affordable option in far-flung, low-resource areas.

Public support for herbal medicines is regaining traction. And this renewed support to herbal medicines can be used as an impetus to fill the gaps of the country’s problematic, devolved health care system.

Policy Analysis

Increasing need for affordable, available, cost-effective treatment options

Even with the promotion of herbal medication, mostly by the government and advocates of TACM, some medical professionals discourage its simultaneous use with conventional treatment2. Up to this day, doctors fear that herbal medicines could affect the efficacy of conventional drugs and/or produce adverse drug reactions not currently known to man. Despite this, some Filipinos prefer herbal medicine over modern medicine citing reasons including affordability and availability3,4.

Herbal medicines are proven to be affordable alternatives to expensive conventional medicines especially in the treatment of common colds, cough, fever, some skin and parasitic infections, open wounds, and even in the alleviation of pain.

High out-of-pocket expenditure in the absence of insurance coverage

Currently, Philhealth does not cover outpatient medicines and the price of these medications is entirely shouldered by the patient4. Moreover, only three of the ten herbal medicines approved by DOH and FDA (lagundi, sambong, tsaang gubat) are included in the 8th Philippine National Drug Formulary (PNDF)5 – the basis of Philhealth in reimbursing medicines to health providers.

Lack of government facilities to increase herbal medicine supply

The Philippine Institute for Traditional and Alternative Health Care (PITAHC) has only four herbal plantations in the country (Tacloban, North Cotabato, Davao, and Tuguegarao). These plantations grow herbal plants and manufacture them as herbal medicines in capsule form. In 2015, these plantations generated P74 million in net sales of herbal medicines supplied to the Department of Health and its retained hospitals.

Recommendations

The integration of herbal medicines into key components of the national health system will contribute to the advancement of three health system attributes – equity, efficiency, and sustainability – considered essential to achieve UHC.

  • Equity: Include all ten herbal medicines in the PNDF and Philhealth’s primary benefit package

Philhealth should include DOH- and FDA-approved herbal medicines in its primary care benefit package which has the potential to reduce financial burden, especially among the poor. Inclusion of the remaining seven herbal medicines in the PNDF will allow Philhealth to include all ten herbal medicines when it decides to revise the primary care benefit package and incorporate herbal medications.

  • Efficiency & Sustainability: Establish more herbal plantations in strategic sites across the country

More plantations across the country are needed to increase the supply of herbal medicines to keep up with the growing demand. Mechanisms to widen the coverage of these plantations should be in place, taking into account the need to reach low-resource GIDAs. Establishing additional plantations can uplift the livelihood of local farmers and bring more affordable, safe, and cost-effective medicine to every Filipino.

While adequate infrastructure can boost this integration, building more plantations will require years of planning, budget allocation, and political will. It is imperative then, in the interim, for the government to use other mechanisms such as insurance coverage, community-based health promotion, and efficient allocation of scarce herbal supply to achieve the goal of meeting the health needs of the people at an affordable cost.

Implementation

Short-term: 3-5 years

  • Revise the PNDF to include all ten herbal medicines approved by the DOH with adequate scientific evidence.
  • Provide insurance for non-conventional therapies and products by including evidence-based herbal medicine in Philhealth’s primary care benefit package, OR create a new package for herbal medications.
  • Increase people’s awareness of new and existing policies on herbal medication through quad media (social media, newspaper, television, radio).

Long-term: 5-10 years

  • Build infrastructures for research, development, and manufacture of herbal medicines in strategic places across the country
  • Establish a distribution mechanism to efficiently allocate low-cost herbal medicines across the country, especially in low-resource GIDAs

 

Conclusion

Including herbal medicines in the Philhealth primary care benefit package, and building structures for research, development, and manufacturing of evidence-based herbal medicines support the government’s quest to achieve universal health care. There is no one-size-fits-all policy for the integration of herbal medication with the existing health system. However, these measures, when combined, can contribute to addressing public health challenges or improving health care through the provision of quality, safe, effective, and accessible medicines that are affordable and culturally-acceptable.

References

1 Ulep, V & Dela Cruz, N. (2013). Analysis of Out-of-Pocket Expenditures in the Philippines.

Philippine Journal of Development No. 72, Volume XL Numbers 1 & 2. Retrieved 1 March 2019 from https://dirp3.pids.gov.ph/webportal/CDN/PUBLICATIONS/pidspjd13-oop%20expenditures.pdf

2 Canedo, K. (2017). Cancer doctors warn vs herbal medicines Sunstar. Retrieved 1 March 2019,

from https://www.sunstar.com.ph/article/138279

3 Montecillo, B. (2016). Plants as medicine | The Freeman. (2019). philstar.com. Retrieved 1 March

2019, from https://www.philstar.com/the-freeman/cebu-lifestyle/2016/08/22/1616083/plants-medicine

4 Diego, C. (2019). Siquijodnons opt for herbal home cures vs. modern medicinePCHRD Website.

Retrieved 1 March 2019, from http://pchrd.dost.gov.ph/index.php/events/5870-siquijadnons-opt-for-herbal-home-cures-vs-modern-medicine

5 DOH (2017). Philippine National Formulary Essential Medicines List 8th Edition. Retrieved 1 March

2019 from http://caro.doh.gov.ph/wp-content/uploads/2018/04/PNF-8th-edition.pdf

x WHO & DOH (2019). Health Service Delivery Profile 2012: Philippines. Wpro.who.int. Retrieved 1

March 2019, from http://www.wpro.who.int/health_services/service_delivery_profile_philippines.pdf

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