The frontline

As a nurse, waking up each day is a struggle knowing that there is a high risk for us to acquire the disease. However, we are constantly reminded of our duty to the people. That it is our duty and responsibility to help those in need, especially the poor, weak, and vulnerable.

Times like this make us realize that effective communication is key. Sadly, the field of health has failed to do it well in many instances. Today, more than ever, I fervently ask our leaders to first show TRANSPARENCY. Make things clear for us. Make us understand how things will be managed, coordinated, and disseminated. Make us feel that you are on top of this and that processes are as clear as they can be.

Second, I ask for CONSISTENCY. We are tired of hearing conflicting statements, especially those from the higher ranks. Such conflicting statements create confusion which in turn causes panic. Let there be a single message from a single source.

Finally, I ask for INTEGRITY. Let us not fool each other. Again, kabaro mo na. Sana hindi ka na isahan pa. Tayo-tayo dapat ang nagtutulungan. Hindi dapat nag-gugulangan. Let us be honest to each other so we can all work well together. After all, we all aim for one goal – the end of this crisis.

The coming weeks will show how resilient and responsive our health care system is. The circumstances will test how our current systems will adapt and change according to the pressing needs of the people. Our experiences during this pandemic will surely change how we will implement the UHC law in a bigger scale in the following years.

Please pray for everyone, especially those in the frontline. It is a scary, scary world and we have nobody to save us but ourselves. Ingat!

DISCLAIMER: There is no way this post pertains to a particular individual, hospital, or organization. Before you try to twist whatever I said in this post and send complaints, please clarify them first with me. Send me a message. It’s free.

Ampatuan Massacre Promulgation

It took ten years to reach this point; a manifestation of the slow, inefficient process of our Justice System.

Court’s decision today on ‘Ampatuan Massacre’, however, gives us hope that justice is not entirely elusive. Even those who cling to power cannot evade justice.

Justice will only be truly served when our journalists and other members of the press can continue to tell the truth without fearing for their lives. There is more that needs to be done.

Alagaan ang mga tapag-alaga

PNA National Day of Protest | 8 November 2019 | Kartilya ng Katipunan

Minsan. Minsan kahit katatapos lang natin sa trabaho ay iniisip na natin ang susunod na araw. Kumusta na kaya ang pasyente kong si Juan? Nainom na kaya niya ang mga gamot niya? Kumusta na ba si Maria? May kirot pa kaya siyang nararamdaman?

Madalas. Madalas iniiwan natin ang trabaho natin na mistulang post-apocalytic scene sa isang pelikula. May mga pasyente na nagsisiksikan sa iilang kama. May mga pasyente na walang mainom na gamot dahil walang pera. At may mga nurse na kayod kalabaw pero kahit pagod, gutom at ihing-ihi na, nakangiti pa ring nakaharap sa mga pasyenteng sinumpuan niyang paglingkuran. Kahit gaano man kahirap gampanan ang mga responsibilidad ng isang nars, paulit-ulit pa rin nating pinipili na maglingkod sa bayan.

Bakit nga ba tayo gumagawa ng ingay? Bakit ba paulit-ulit ang ating panawagan? Iisa lang ang sagot – dahil hindi sila nakikinig. Gusto natin alagaan ang ating mga pasyente nang husto at may dignidad. Gusto natin magtrabaho bilang mga nars na nirerespeto at binibigyang halaga. Gusto natin muling ipakita ang ligaya sa likod ng natatanging pag-aalaga. At, gusto natin na umuwing panatag na maaalagaan din natin ang ating mga sarili at pamilya.

Tunay nga ba ang kabataan ang pag-asa ng bayan? Ngunit, paano tayo aasa sa isang bulok na sistema? Para sa mga kabataang nars na gaya ko, napakahalaga ng pagtitipon na ito. Ito ang araw na minarkahan natin ang simula ng mas marami pang aksyon mula sa nagkakaisang mga nars na naglilingkod para sa bayan. Ito ang simula ng pagpapanday ng isang mas magandang bukas para sa aming henerasyon at sa mga susunod pa. Ito ang nagsisilbing katibayan na may pag-asa pa. May pag-asa pa para sa isang mas maayos, tuwid at makatao na sistemang pangkalusugan.

Hiling ng mga kabataan na tulad ko ang isang bukas na hindi perpekto ngunit malapit sa uliran: sapat na sahod, regularisasyon at hindi kontraktwalisasyon, makatwirang nurse-to-patient ratio, at ligtas at maayos na lugar ng trabaho.

Alam natin na hindi rito nagtatapos ang laban. Alam din natin na mahaba-haba pa ang lalakbayin. para sa mga inaasam. Pero kaming mga kabataan, lubos na umaasang ngayon kami ay tuluyang pakikinggan. Sa huli, iisa lang naman ang ating panawagan: alagaan din ang mga tagapag-alaga.

SG15, ipatupad!

Sahod ng nurses, dagdagan! Dagdagan!

War on Drugs or War Against the Poor?

Since Duterte’s inauguration as President of the Philippines in 2016, the country has been bombarded by news about extrajudicial killings and human rights violations. Duterte himself, in a number of speeches, encouraged policemen and his allies to track and kill drug users and pushers. More recently, he has advocated lowering the age of criminal liability – a setback in reforming the juvenile justice system. Clearly, this administration shows an extreme obsession with crimes. Thus, one can say that the central theme of this administration’s governance is anchored on crime, both prevention and promotion.

Though the information gathered by the Philippine Human Rights Information Center (Read: PhilRights) is limited to cases in the Greater Manila Area and Bulacan, the findings of PhilRights provide an extensive documentation and presentation of human rights violations and extrajudicial killings committed under the so-called War-on-Drugs of Duterte’s Administration.

Duterte’s War-on-Drugs literally painted the town red. As documented by PhilRights, majority of the victims of EJKs are in their productive ages and many are primary breadwinners of their families. Many of them are minimum wage earners; some are unemployed and/or earn way below the minimum wage. Majority of the victims lived in urban poor communities, mostly in informal settlements and relocation sites. Many of them had low educational attainment which limited their access to better work opportunities.

These findings suggest that the current ‘war on drugs’ targets the poor, vulnerable, and disadvantaged members of our society. No matter how and where the killings took place, the fact that all these documented victims come from poor families is alarming. As most of these victims are breadwinners of their (usually extended) families, killing them added a burden to their families already suffering from the effects and consequences of the unending cycle of poverty.

What is the motivation of this war against drugs? Why is the poor often the target of these operations? It seems that the government and its allies are merely scratching the surface, targeting the most vulnerable instead of capturing the mastermind and drug lords. Why is this government resorting to killing its citizens instead of pushing for a healthier community conducive for rehabilitation? More importantly, where in this scenario can we say, “buhay ay langit sa piling mo”?

This bloody war against the poor has to stop. It is cruel, unjust, and detrimental to a society that is barely inching towards sustainable development. It is in no way reflective of the values of the country. The war on drugs is not “maka-diyos”. No religion, even spiritual beliefs, encourages the killing of other people. The war on drugs is not “maka-tao”. We deprive the victims (or accused) of due process, and in essence punish them for crimes that they might not have even committed. The war on drugs is not “makabansa”. It perpetrates hatred and abuse of authority. It divides the nation. It pushes our countrymen further below the poverty line. It breeds a society where the poor remains poor and the helpless becomes more powerless.

Will there be an end to this? Let our dying declaration be “ang mamatay ng dahil sa’yo”. To die not because of the country, but to die for the country.

Welcome 2019!

As we enter the New Year, we thank God for all His blessings this year of good health, of well-being, of close family and friends. And as we look at the uncertainties in our country in 2019, may we be likened to to biblical humble donkey that carries Hope, Peace and Love as we journey in these troubled and dark times and declare God’s glory to all and sundry wherever we are or go. Happy New Year to you and your loved ones! >Reggie & Laine, Regina, Reiner, Riazel and Ricci Jarabe-Tamayo Family


POLICY ANALYSIS REPORT: Graphic Health Warnings Law (Part 4)


Evidence is one factor that influence policy-making and this can be generated through research. Research is a scientific process designed to produce new knowledge to improve the understanding of the world or to explain a phenomenon. It has substantially contributed to this policy in many ways at various stages of the policy cycle. The succeeding sections present the role of research in these stages.

Issue Recognition and Policy Identification

Research, in the early stages of the policy cycle, helped define the nature and severity of the problem. It helped issues get into the government’s policy agenda. Research evidence were effectively utilized by several policy actors such as the WHO, DOH, and anti-tobacco groups.

Health statistics from the DOH provided policy actors and the public with the information about the health effects of tobacco use, specifically tobacco-related diseases. This information supported the argument for the enactment of better, stricter tobacco control policies that will lessen the burden of these diseases.

National and global surveys such as the Global Adult Tobacco Survey (GATS) and the Global Youth Tobacco Survey (GYTS) helped monitor tobacco use among Filipino adults and the youth. These surveys provided essential information regarding the tobacco epidemic. These surveys covered essential indicators such as (1) knowledge and attitudes towards cigarette smoking, (2) prevalence of cigarette smoking, (3) role of media and advertising in the use of cigarettes, (4) access to cigarettes, (5) environmental tobacco smoke, and (6) cessation of cigarette smoking. Information from these surveys stimulated the development of tobacco control policies and programs in the country.

Global and local surveys proving the ineffectiveness of text-only health warnings on cigarettes products to change smoking behavior prompted policy actors to review existing policy options. As such, studies proving the effectiveness of large graphic health warnings in changing smoking behavior and deterring non-smokers from taking up the habit were used as justifications for the enactment of a policy similar to the recommendations of the WHO.

Policy Formulation

Research has also played a significant role in the formulation of the policy. The WHO FCTC, a set of tobacco control guidelines established from systematic review of research evidence, contributed to the introduction of strong health warnings and the adoption of graphic health warnings in the country.

In the Philippines, a concept test on cigarette packaging designs was conducted by FCAP in 2007 through a quantitative Concept Acceptance Test. The nationwide study provided a background on the public’s perception about smoking and its health effects. Likewise, the study provided feedback on various graphic health warning mock-ups that helped anti-tobacco advocates choose which were the most effective for the Philippine market.

Policy Implementation

Currently, no study has explored the impact and effect of the graphic health warnings on smoking behaviors of Filipino smokers nationwide. A small study, however, that explored how graphic health warnings had affected smoking behavior of Quezon City residents was conducted by UP Diliman Communication Research students in 2016.

The researchers surveyed 402 Quezon City smokers and conducted two focus group discussions from October to November 2016. The results of the study suggest that thinking about the dangers of smoking and correct knowledge of smoking-related diseases are the strongest factors correlated with the intention to quit or change smoking behavior which is in congruence with the overall goal of the GHW law (Aseo et al., 2016).

The study also presented aspects of the implementation where the policy is problematic. First, the fact that buying cigarette on a per-stick basis is prevalent in the Philippines greatly reduces the probability of smokers being informed of the dangers of tobacco use. And second, most smokers do not rely on tobacco packages for health information. Majority of smokers actually rely on other media (i.e. television) for information on smoking.

What’s Next?

While current evidence suggests that graphic health warnings are effective in informing smokers of the health effects of tobacco consumption, future research will be helpful in evaluating the effectiveness of graphic health warnings in changing consumer behavior (i.e. decreasing tobacco consumption, deterring non-smokers from initiating smoking). Findings from future studies will eventually determine the fate of the policy – whether to improve or repeal the policy.



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POLICY ANALYSIS REPORT: Graphic Health Warnings Law (Part 3)


Principal-Agent Approach

The policy uses the principal-agent approach of implementation where the government has mandated its various agencies to implement the law in various capacities. Other than the DOH, several government agencies are also given mandates for purposes of the implementation of this law.

The Bureau of Internal Revenue (BIR) is mandated to ensure that cigarette stamps are not affixed on noncompliant packages and to certify under oath that the products withdrawn are compliant with R.A. No. 10643. The Inter-Agency Committee on Tobacco (IAC-T), created under R.A. No 9211, monitors overall compliance with the law, and institutes the appropriate action for any violation of the law. The Department of Trade and Industry (DTI) shall hear complaints of violation of this law filed by the IAC-T or any private citizen, corporation, or organization. Finally, the Department of Education (DepEd) is mandated to use the Graphic Health Warnings templates to educate children on the ill-effects of tobacco and ensure that these are included in relevant subjects under the K-12 curriculum.


Factors Affecting Implementation

While many advocates laud the passage of the GHW as a tobacco control measure, much has to be done in its effective implementation. The policy addresses the issue on information asymmetry; however, it lacks the ability to fully change several mental models (i.e. smoking is cool & masculine) and other unique factors imbedded in the Filipino culture that could drive or deter the implementation of the policy.

Tobacco Industry Interference

While there seems to be a strong political will from the DOH leadership to sustain the measure, there is certainly room for some resistance to change. Many stakeholders have identified the PTI as a stakeholder that actively opposes GHW as a tobacco control policy. While this opposition was made apparent by PTI in the past, it eventually expressed moderate opposition to this policy during the policy formulation phase when it realized that the enactment of the policy was inevitable.

As the sole group of opponents with the intention to protect their commercial interests, tobacco companies effectively used their power to challenge, discredit, and obstruct the implementation of effective tobacco control measures such as the GHW Law. Due to their overwhelming resources and ability to effectively mobilize these, PTI has the capacity to hire the best law firms for their legal defense pitted against underpaid government lawyers with a ton of caseloads.

Research conducted by anti-tobacco groups showed that these actions included (1) demanding a seat at government negotiating table, (2) drafting and distributing sample legislation that is favorable to the tobacco industry, (3) attempting to bribe legislators, (4) financing government initiatives to gain favor, (5) using tobacco farmers as ‘front groups’, (6) and defending commercial profit (HealthJustice Philippines, 2014).

The PTI has a long history of opposing tobacco control measures. In 2014, PTI successfully reduced the size of originally proposed graphic health warning labels on cigarette packs and convinced legislators to place them on the lower portion of the front and back panels which is opposite the recommendation of the WHO (SEATCA, 2018).

The tobacco industry’s powerful influence on the policy process also became apparent during the policy’s implementation. Despite proven capacity to produce cigarette products with graphic health warnings, Philippine tobacco companies delayed the implementation of the law citing administrative feasibility, logistical nightmare, and costly exercise among their reasons. For transnational companies, this was a case of double standards.

The law took effect on March 2016, two years after it was signed into law, where local and imported cigarettes started to be sold in packages with graphic health warnings. However, based on the law, the absolute prohibition on the retail sale of tobacco products without GHW started only on November 2016. Manufacturers and importers were given a year to print the graphic health warnings on tobacco packages and retailers have been given an additional eight months to exhaust stock with text warnings.

Many anti-tobacco groups blame the powerful tobacco lobby for the delay. This further demonstrated the power of tobacco companies to influence not only policy formulation but also the implementation of the law. Coincidentally in 2014, the WHO released the Tobacco Industry Interference Index showing that the Philippines ranked third among countries with strong industry interference with a performance rating of 71 following Indonesia and Malaysia.

Most stakeholders also do not agree with PTI being included in the Inter-Agency Committee-Tobacco (IAC-T). Most stakeholders believe that PTI could meddle with decision about cigarette policies of the government by sitting in a government tobacco regulatory body that seeks to regulate their industry. Many of these stakeholders have called on the government to remove the PTI from the IACT.

There is no doubt that the passage of the GHW law greatly benefited from strong political support, leadership from DOH, and advocacy-driven action by anti-tobacco groups. The country’s experience may not be comparable with the experiences of other countries that have implemented similar reforms. The tobacco industry’s power remains a significant influence in the tobacco control policy process of the Philippines. However, the experiences with the GHW policy process in the country has established a strong foundation for future reforms, especially in tobacco control.


Health information source

With the end goal of effectively instilling health consciousness and deterring potential smokers, the GHWs on tobacco product packages were introduced to deliberately present the harmful effects of tobacco use and to change the wrongful notions associated with smoking. Graphic health warnings are intended to prompt the smokers to think that they could contact diseases depicted in the pictures. Worldwide, GHWs were proven effective in prompting smokers to think about the dangers of smoking which is associated with increased intention to quit.

It is assumed that (1) the more smokers think about the dangers of tobacco use, the more likely they are to consider quitting; (2) and exposure to the dangers of smoking will prevent non-smokers and the youth from initiating tobacco use. This is where the graphic health warnings should supposedly show their impact.

In the case of the Philippines, this is not entirely true. Graphic health warnings lag behind other media as a primary source of information about smoking. It was found that smokers prefer television as primary source for smoking information. Not much has changed since 2008 when the study by FCAP found that 77% of smokers saw warnings on television while only 19% saw them on cigarette packaging.

A more recent study showed that 73% of smokers relied on television to learn about tobacco-related diseases (Aseo et al., 2016). Graphic health warnings only ranked as the second most cited source of information about the health effects of tobacco use. The same study found that majority of smokers had seen the graphic health warnings on cigarette packages. Some of the respondents said they were disgusted and scared by the graphic health warnings and actually prefer throwing the packs away. However, some of them did not pay attention to the graphics and simply threw the cigarette packs.

The use of GHW may only serve its purpose to a few smokers knowing the fact that most of these smokers actually rely for information through media other than the graphic health warnings printed on tobacco packages.


Mode of purchase

The Philippines was once called as a country having a “sachet economy” as it allows a consumer in making smaller cash outlays for smaller packages. Most Filipino smokers resort to buying one or two sticks at a time with an accompanying free light-up service from the vendor instead of buying a pack of cigarettes. The culture of per-stick buying in the country has greatly affected the implementation of graphic health warnings on tobacco packages.

Only about 20% buy cigarettes per pack (versus about 80% buying per stick) making it difficult to ascertain the effectiveness of GHW on tobacco packages in changing the tobacco landscape of the country (Aseo et al., 2016). Buying cigarettes per stick as opposed to buying per pack significantly removes the probability of a smoker or potential smoker of seeing these GHWs and thus, defeating the purpose of the policy.

The DOH was concerned about this aspect of the policy’s implementation –  cigarettes sold per stick by vendors or retail stores. Hence, in 2016, the Department tapped local government units (LGUs) to help monitor the full implementation of the law at the street or community level. To date, no policy has been issued to regulate the sale of cigarette products per pack at the community level.

In general, the graphic health warnings have been proven to be effective in informing smokers about the dangers of tobacco use. It plays a huge role in changing the behavior of smokers regardless of literacy and economic class. It has been shown that around 42 percent of those who changed their behavior said the graphic health warnings had a big impact on their decision (Aseo et al., 2016). But despite these evidence, graphic health warnings fall short in attaining the maximum benefit it promised due to lapses in the policy’s implementation.