Pen Point 49

Various provider payment mechanisms will continue to exist in the country’s health care system. Emphasis is placed, however, on the current movement towards using performance-driven, prospective payments (e.g. Global Budget Payment) based on diagnosis-related groups (DRG). The shift to DRG-based GBP will not be easy. Mechanisms should be in place to avoid underprovision and ensure quality health care.

At the end of it all, “mixing” of provider payment mechanisms can be complementary or compensatory. It is promising how incentives will come into play when these mechanisms align themselves during the implementation of the UHC law.

Happy to know that PHIC is now working on this with various agencies. Very few hands on deck though.

Pandemic Financing: How the World is Funding the COVID-19 Response (Part 1)

Introduction

Many countries are scrambling to respond to the COVID-19 pandemic. The primary focus has been on strengthening health systems to improve surge capacity1,2. At the same time, countries are faced with the difficulty of balancing the demands of responding to the pandemic with the need to maintain the delivery of essential health services2. This increasing demand for health care can further strain health systems around the world. Thus, resulting in a dramatic increase in direct mortality from the outbreak and indirect mortality from preventable and treatable health conditions2.

A key challenge to the pandemic response is the struggle to reconcile scarce resources with many competing priorities. Many health systems, however, were already overwhelmed and underfunded even before the pandemic3. Unsurprisingly, the COVID-19 pandemic has caused a significant blow on the global economy, further constraining the fiscal capacities of economically-vulnerable countries3,4.

Timely policy actions are crucial to mitigate both the health and economic shocks brought about by the pandemic5. Therefore, governments must create a public finance environment that can provide sufficient funding to ensure a comprehensive pandemic response while also taking into account economic and fiscal constraints6.

How is the expression of health valuation and prioritization highlighted in the COVID-19 response?

Health financing policies are required to strengthen the pandemic response. Such policies should focus on (1) raising adequate revenues, (2) organizing these revenues to maximize risk-sharing across the entire population, and (3) mobilizing public funds so that they can be effectively translated into the provision of health services7.

Population-based services, such as comprehensive surveillance, data and information systems, and communication and information campaigns, take priority in the pandemic response. Funding these health services will help ensure that public health functions needed to respond to the crisis are all in place8. Unfortunately, in many countries, investment in the national capacity to prevent, detect, and respond to pandemics was not prioritized in recent years8. In some countries, a systematic financing response has not been established to help address these capacity gaps9.

Additional domestic spending can come from a mix of sources and is used to address different health system issues arising from the pandemic5. In Lithuania, the additional expenditure amounting to $386 purchasing power parity (PPP) per person was intended to cover equipment, salaries, and social security coverage10. In contrast, some countries, such as Bosnia and Latvia, have allocated less than $20 PPP per person from domestic resources for their pandemic response10. It is also interesting to note the variation of health spending across countries. Some countries have large additional budgets but have spent only a fraction so far. France and Croatia spend less than 2% of their regular health spending while Cyprus and Lithuania spend 12.4% and 27.2% of their regular health spending, respectively10.

The situation, then, begs us to ask the question, “How much additional funding should countries spend on their COVID-19 response?” Truth be told, it is difficult to determine the right amount of health spending for a pandemic response. The answer is probably context-specific and highly depends on the needs of the country. What is certain, however, is the fact that more additional funding will be required to meet the growing demand for non-essential health services together with the public health measures employed in the pandemic response. Undoubtedly, there will be higher health expenditure and more budget injections throughout the COVID-19 pandemic.

What are the challenges in financing the COVID-19 response?

In response to this, many countries have already reconfigured health service delivery to meet the immediate health care needs of their populations. However, a supportive health financing response is necessary to scale up both population-based and individual services, especially in countries that heavily rely on out-of-pocket payments1,8. Many of these countries were already experiencing significant gaps in health system coverage which can pose additional challenges to mitigating both health and economic shocks caused by the COVID-19 pandemic5.

1.  Inadequate sources of funding

Like previous public health emergencies (e.g. Ebola), the COVID-19 pandemic will again test public financial management systems in their capacity to support fiscal objectives. Challenges that these systems will face may come from (a) reassessing fiscal policy needs and identifying additional financial resources; (b) ensuring timely availability of funds to service delivery units; (c) tracking accounting for transparent reporting; and (d) ensuring business continuity11. Some countries will have an array of emergency response mechanisms at their disposal and most countries will utilize one or more of the available health financing tools to cope with emergency spending. Through public financial management systems, some governments have the capacity to activate contingency funds in emergency situations including pandemics5,6.

Arguably, major gaps in the health financing system are more challenging to address at the subnational level. In the Philippines, for example, funding level and spending capability vary substantially by local government unit. Some local government units have insufficient funds or sub-optimal budget allocation to implement an effective response to public health emergencies12. Thus, funding for a pandemic response may not always be allocated or readily available to support priority public health measures, especially at the subnational level.

Reprioritization through virements between government programs has been considered the primary action in securing budget funding for immediate pandemic response6. Private donations from individuals and local businesses have also been relied on as secondary sources of additional funding. Reallocating existing health budgets and private donations, however, may not be enough to fund health financing needs in the long run10. Conversely, many of the countries with low levels of an additional spending budget will eventually rely on funding from external donors such as the World Bank10.

2.  The need for timely and appropriate fund disbursement

More than the availability of funds, a financing mechanism is essential for the timely response to public health emergencies. Timely and appropriate financial decision-making requires a coordinated and harmonized governance structure across government agencies. The speed by which a country can respond to a public health emergency may depend on its public financial management system which establishes the rules and regulations for budget allocation and spending. In Australia and France, these rules are flexible which allowed for the rapid reallocation of program-based budgets and the immediate release of such funds to health care providers13.

An accelerated disbursement process will allow advance appropriation and fast-track payments to meet the spending needs of health systems. Several countries have explored different approaches to accelerate the release of public funds to government agencies and/or health service providers both in national and subnational levels14. In India, for example, procedures for fiscal transfers to subnational levels have been accelerated by authorizing emergency spending transactions without the approval of the Minister of Finance15.

In the Philippines, a quick response fund of the Department of Health is available and can be accessed when needed during times of emergencies and disasters. However, there is limited coordination and flexibility to reallocate or transfer the quick response fund to other key government agencies to support the response to public health emergencies12. The total turn-around time for the release of this fund takes about one to three weeks. When the disbursement of the fund is anticipated to last more than one week, the requesting office is asked to initially utilize their regular funds12. Hence, there is a need to enhance the capacity to optimize resource allocation by instituting innovative financing mechanisms that can hasten the disbursement of funds where they are needed most.

References:

  1. World Health Organization. How to purchase health services during a pandemic ? Purchasing priorities to support the. 2020;(April). https://www.uhc2030.org/blog-news-events/uhc2030-blog/how-to-purchase-health-services-during-a-pandemic-purchasing-priorities-to-support-the-covid-19-response-555353/.
  2. World Health Organization. Maintaining essential health services : operational guidance for the COVID-19 context. 2020;(June). https://www.who.int/publications/i/item/covid-19-operational-guidance-for-maintaining-essential-health-services-during-an-outbreak.
  3. Kurowski C, Evans D, Irwin A, Postolovska I. COVID-19 (coronavirus) and the future of health financing: from resilience to sustainability. Investing in Health. https://blogs.worldbank.org/health/covid-19-coronavirus-and-future-health-financing-resilience-sustainability. Published 2020. Accessed June 13, 2020.
  4. Development Aid. Financing of pandemic response: where does the money come from? https://www.developmentaid.org/#!/news-stream/post/62753/financing-of-pandemic-response-where-does-the-money-come-from. Published 2020. Accessed June 13, 2020.
  5. Thomson S, Habicht T, Evetovits T. Strengthening the health financing response to COVID-19 in Europe. 2020.
  6. Barroy H, Wang D, Pescetto C, Kutzin J. How to budget for COVID-19 response? 2020;(March):1-5. https://www.who.int/who-documents-detail/how-to-budget-for-covid-19-response.
  7. World Health Organization. Health systems governance and financing & COVID-19. https://www.who.int/teams/health-financing/covid-19. Published 2020. Accessed June 14, 2020.
  8. World Health Organization. Priorities for the Health Financing Response to COVID-19. DOI:10.1596/33738
  9. Glassman A, Datema B, McClelland A. Financing Outbreak Preparedness: Where Are We and What Next? Cent Glob Dev. 2018. https://www.cgdev.org/blog/financing-outbreak-preparedness-where-are-we-and-what-next.
  10. Cylus J. HOW MUCH ADDITIONAL MONEY ARE COUNTRIES ALLOCATING TO HEALTH FROM THEIR DOMESTIC RESOURCES? https://analysis.covid19healthsystem.org/index.php/2020/05/07/how-much-additional-money-are-countries-putting-towards-health/. Published 2020. Accessed June 18, 2020.
  11. Stone M, Saxena S. Special Series on Fiscal Policies to Respond to COVID-19 Preparing Public Financial Management Systems for Emergency Response Challenges 1. https://blog-pfm.imf.org/pfmblog/2020/03/preparing-public-financial-management-systems-to-meet-covid-19-challenges.html.
  12. World Health Organization. Joint External Evaluation of IHR Core Capacities of the Republic of the Philippines. Geneva, Switzerland; 2019. DOI:10.1142/9789812817945_0010
  13. Gupta S, Barroy H. The COVID-19 Crisis and Budgetary Space for Health in Developing Countries. https://blog-pfm.imf.org/pfmblog/2020/03/preparing-public-financial-management-systems-to-meet-covid-19-challenges.html. Published 2020. Accessed June 21, 2020.
  14. Barroy H. No calm after the storm: time to retool country PFM systems in the health sector. https://p4h.world/en/who-wb-no-calm-after-the-storm-time-to-retool-country-pfm-systems-in-health-sector. Published 2020. Accessed June 21, 2020.
  15. Verma A, Raj A. PFM Solutions in India to Combat the COVID-19 Pandemic.

 

NOBODY LEFT BEHIND: THE CHALLENGE OF ENSURING PHILHEALTH COVERAGE AMONG OFWS

EXECUTIVE SUMMARY

In order to reduce the financial uncertainties associated with future illnesses, Overseas Filipino Workers are encouraged to enroll themselves in the national health insurance program. However, not all OFWs are enrolled in the program or are actively paying their premiums. The reasons behind this include limited knowledge about Philhealth and its services. This, coupled with poor health-seeking behaviors, had economic and health consequences making it necessary for the government to intervene.

Philhealth is suffering from low premium collections brought about by a decline in membership among OFWs observed in previous years. Therefore, Philhealth is challenged to identify effective strategies that can improve OFWs’ health-seeking behaviors and access to health insurance.

Some strategies that can be considered include the following:

  • Expansion of the coverage of information, education, and communication campaign
  • Partnerships with government and private agencies to jointly promote public awareness
  • Inventory and system for reproducing, updating, and sharing of customized IEC materials
  • Digital platforms that remotely provide essential services and address learning needs

Investment in these strategies will be required to address information issues. Such investment, however, will require significant political will, support, and financial investment.

INTRODUCTION

The government plays a crucial role in ensuring that Overseas Filipino Workers (OFWs) and their dependents have access to quality health services without experiencing financial hardship. Through Philhealth, OFWs are guaranteed financial risk protection against the financial uncertainties associated with the need to use and pay for health care services.

The establishment of the National Health Insurance Program should have led to a steady increase of OFWs who are enrolled as members of Philhealth. Unfortunately, the opposite is true. In 2016, the premium payments of OFW Philhealth members amounted to only P823 million. This is below the P1.2 billion premium payments collected in the previous year. Such a decline has been attributed to a huge drop in membership among OFWs.1

Education, sex, civil status, income, among others, were identified as significant factors associated with OFWs’ health-seeking behavior, and membership in and access to social health insurance.2 In an attempt to address the problem of declining membership, Philhealth has conducted various strategies to increase awareness and understanding of OFWs on the promising contributions of Philhealth that ensure access to health care without the risk of financial catastrophe.

But even with these strategies, only 3.6 million out of approximately 10 million OFWs are Philhealth members. OFWs paid a total of P1 billion in premiums in 2019, significantly lower than the P1.7 billion in benefit claims that Philhealth paid out to them and their dependents in the same year.3 Therefore, there is an urgent need to look at other measures and/or improve current methods that can effectively deliver health messages and membership-related information to OFWs. Philhealth’s awareness campaign should go beyond the traditional and seek to use more effective strategies that can address the knowledge deficit in target audiences.

POLICY ISSUE

Philhealth is suffering from low premium collections brought about by a decline in membership among OFWs observed in previous years. Various factors have been looked at as possible barriers or facilitators to membership in and access to Philhealth.  In 2017, sociodemographic characteristics (i.e. age, sex, level of education, income, number of children, and having or not having a partner) were found to be associated with health-seeking behaviors and/or OFW membership in Philhealth.2

Information campaigns tend to have a one-size-fits-all design. Limited knowledge of Philheath membership and premiums and poor health-seeking behaviors were found in some subpopulations (e.g. women, individuals with low education, unmarried, young adults). Thus, increasing the need for audience-specific programs. This is challenging for Philhealth because of the range of migrant occupations and diversity of backgrounds of OFWs. These profiles are essential to consider when developing information, education, and communication (IEC) materials.4 

Information is disseminated through limited means. The majority of OFWs get information about Philhealth in pre-departure orientations usually organized by government agencies and private recruitment agencies. It remains unclear whether OFWs acquire the necessary information from these orientation seminars. There have been reports that some agencies do not provide the required seminar but still issue certificates to OFWs.4

Information dissemination lacks coordination among government agencies. In 2015, the POEA stopped collecting OFW Philhealth premium payments which forced Philhealth to market services on its own. Law has also mandated Philhealth to establish overseas satellite offices, or where it is not feasible, designate a focal person in every Philippine Consular Office in all countries where there are Filipino citizens. In 2010, there were only three Philhealth offices abroad.5

Despite efforts to increase awareness among OFWs, Philhealth still fails in effectively delivering its message to the target audience. Thus, membership and premium contributions continue to decline despite government effort to ensure that OFWs and their dependents equally enjoy the promise of universal health care, which is #HealthForAll.

POLICY ALTERNATIVES

To address the issue of declining membership, there is a need to analyze several policy alternatives to increase knowledge and understanding of OFWs of Philhealth programs and services. Some of these alternatives were inspired by the best practices of other government agencies in providing services to OFWs. The proposed alternatives are presented below.

  • Expand the coverage of information, education, and communication campaign with the help of tri-media

There may not be a need to extend the length of orientations. However, expanding coverage should mean including family members in pre-departure orientation seminars. Whether families remain behind or accompany OFWs, there are issues that might need to be addressed during these seminars. Moreover, pre-departure seminars are not the only means to reach OFWs. Print, broadcast (television and radio), and new media (digital and social media) can also be suitable channels for information dissemination. These platforms, however, are less participatory and more expensive.

  • Forge partnerships with government and private agencies to jointly promote public awareness on coverage and benefits for OFWs

Similar to the strategy of several agencies, Philhealth can establish a massive information campaign together with other government agencies that are directly involved in overseas employment. Some examples include the regional information caravans being conducted by OWWA6; comprehensive pre-employment and pre-departure orientation seminars jointly conducted by POEA, OWWA and the Insurance Commission7; and the placement of co-branded promotional displays in airports across the country in partnership with the Bureau of Immigration.8

  • Create an inventory and system for reproducing, updating, and sharing of customized IEC materials

Information campaigns for programs and services can be more effectively delivered when anchored to health risks and consequences. An inventory of customized materials produced by government agencies and NGOs, and a system of reproducing, updating or sharing these materials, can be established. Customized materials should address the learning gaps of target populations to achieve a more targeted approach to information dissemination.

  • Invest in digital platforms to remotely provide essential services and to address the learning needs of OFWs

Technology is evolving and so should the approach in changing how people live, behave, and decide for their health. Philhealth can develop a suite of digital tools that meets user needs and are free at the point of use. A Facebook or website bot that can provide answers to questions in a personal one-to-one way using mobile phones can be considered. Similarly, online learning systems, such as those being developed by the Department of Labor and Employment, can be vital in reaching OFWs with varying learning needs. Finally, a Philhealth member mobile app can be developed to view statements of accounts and pending payments, apply for reimbursements, upload important documents, and electronically pay for due premiums. Mobile apps can make transactions easier in the comfort of members’ homes. 

CONCLUSION AND RECOMMENDATIONS

Based on this analysis, it is recommended for Philhealth to address the policy issue using an integrated approach comprised of all the suggested alternatives. These alternatives are effective communication strategies ensuring better coverage and access to essential information related to Philhealth programs and services. These alternatives have been used by other agencies around the world and have been proven effective in changing the perception and behavior towards health.

To maximize the benefits of the use of these alternatives, it is recommended that Philhealth invests in studies seeking to enumerate other strategies that prospective members find useful and effective. The use of tri-media and technology can inform a larger audience while considering the unique needs of target subpopulations in most need of information. While Philhealth and the national government can appropriate funds for the implementation of these alternatives, local government units can shoulder some of the implementation costs as part of their health promotion activities.

Policy changes in information, education, and communication can have a synergistic effect in terms of increasing awareness or understanding of Philhealth’s programs and services, providing access to these services especially for those working overseas, and improving health-seeking behaviors. Using evidence-based strategies to address information needs, and thereby increase Philhealth membership, ensures that in our journey to universal health care nobody is left behind.

REFERENCES:

1 Why is there a steep decline in OFW contributions to PhilHealth? – The Manila Times. (2020). The Manila Times. Retrieved 28 May 2020, from https://www.manilatimes.net/2017/03/27/opinion/analysis/steep-decline-ofw-contributions-philhealth/319359/

2 Jabar, M. A. (2019). Factors influencing health-seeking behavior among overseas Filipino workers. International Journal of Healthcare Management, 1-13.

3 Yee, J. (2020). PhilHealth to hike premium rates starting next yearNewsinfo.inquirer.net. Retrieved 28 May 2020, from https://newsinfo.inquirer.net/1177046/philhealth-to-hike-premium-rates-starting-next-year

4 Asis, M., & Agunias, D. R. (2012). Strengthening pre-departure orientation programmes in Indonesia, Nepal and the Philippines. International Organization for Migration and Migration Policy Institute.

5 Philhealth Advisory No. 11-02-2010. Philhealth.gov.ph. Retrieved 28 May 2020, from https://www.philhealth.gov.ph/advisories/2010/adv11-02-2010.pdf

6 OWWA holds reintegration info caravan, membership campaign. (2019). Pia.gov.ph. Retrieved 28 May 2020, from https://pia.gov.ph/news/articles/1029385

7 Pre-departure awareness on insurance benefits for OFWs set | Department of Labor and Employment. (2017). Dole.gov.ph. Retrieved 28 May 2020, from https://www.dole.gov.ph/news/pre-departure-awareness-on-insurance-benefits-for-ofws-set/

8 Pag-IBIG and Bureau of Immigration join hands to promote OFW membership – ADFIAP. (2015). ADFIAP. Retrieved 28 May 2020, from http://www.adfiap.org/news/members-news/pag-ibig-and-bureau-of-immigration-join-hands-to-promote-ofw-membership/

Health Economics Series: Cost Efficiency and Allocative Efficiency

A government can be cost-efficient but have poor allocative efficiency. Cost efficiency achieves the maximum health benefit at a given cost while allocative efficiency maximizes the health of society by achieving the right mixture of health goods and services according to preferences.

Say for example the government wants to produce more midwives under a national scholarship program to address the lack of health care professionals in community health care settings, particularly in BEMONC facilities. The choice of producing more midwives gained traction because it was perceived as relatively cheaper than producing medical doctors. If the cost of producing one midwife is 150,000, the cost of producing one doctor is 200,000 and the budget is 100,000,000, the government will have to look for a combination of inputs that results in the maximum output at minimal costs in order to be cost-efficient.

The red points in the first graph (Figure 1) shows different combinations at which the production of midwives and doctors are technically efficient. The green point shows the maximum number of midwives and doctors that can be produced at the given budget of 100,000,000. In this example, the government is cost-efficient if it produces 400 midwives and 200 doctors.

While producing these numbers of midwives and doctors are said to be cost-efficient, it would not immediately mean that the action depicts allocative efficiency. This type of efficiency occurs when goods (midwives/doctors) are distributed or allocated according to consumer preferences. Usually, allocative efficiency is seen as an output level where price (P) is equal to the marginal cost (MC) of production because the willingness to pay is equivalent to the marginal utility derived from the good consumed. Thus, the optimal distribution is achieved when marginal utility (MU) equals marginal cost.

At an output of 100, the marginal cost of the good is roughly 100 (Figure 2). But at is this output, society is willing to pay a price of 600. Therefore, society is said to be under-producing midwives. At an output of 500, the marginal cost is 600, but society is willing to pay only 100. Thus, society is said to be over-producing midwives. In this example, allocative efficiency will occur at a price of 350 with an output of 300. This is the point where the marginal cost is equal to marginal utility.

Health Economics Series: Average Productivity and Marginal Productivity

Average productivity (AP) is simply the quotient of the total output (O) divided by the number of units of a certain input (I) [i.e. AP = O / I]. Marginal productivity (MP), on one hand, is the additional output derived from an additional unit of a certain input [i.e. MP = ∆O / ∆I].

Example: Suppose that the Philippine Congress is currently deliberating on a bill that seeks to convert the Aparri District Hospital to Aparri Regional Hospital. One of the factors considered in this type of hospital conversion is the increase in the hospital’s authorized capacity which entails the creation of new plantilla positions. We take nursing personnel in the Out-Patient Department as the focus of this example. Table 1 shows the relationship between the nursing input (number of nursing staff), and the desired output (measured in the number of patient visits / attended).

Table 1. Input, Output, Average Productivity and Marginal Productivity for a Proposed Staffing Complement
Input

(Nursing

Staff)

Output

(Patient

Visits)

Average

Productivity

(O/I)

Marginal

Productivity

(∆O / ∆I)

0 0 0
5 10 2.0 2
10 30 3.0 4
15 45 3.0 3
20 50 2.5 1
25 55 2.2 1
30 60 2.0 1

The average productivity provides an insight into the “production process”. This product simply presents the average quantity of service (in this case, nursing services) produced by a nurse. With five nurses, a nurse can attend an average of two patients. Ten and 15 nurses tend to produce the same average productivity per nurse which happens to be the highest among the other averages. At first glance, decision-makers are given the option to choose whether to allocate funds for ten or 15 nurses. Choosing the latter would mean more nurses employed in the government nursing service.

Since decision-makers want to maximize total product, they will look at how adding extra nurses affects marginal product which contributes to the total product. The table shows that adding more nurses generates fewer services in that it demonstrates the law of diminishing marginal productivity. The incremental nurses become less productive due to constraints imposed by other fixed inputs. Thus, at higher levels of output, the marginal productivity of nurses begins to decline. In order for the government to get value for money, decision-makers will look at options where the marginal product continues to rise. In this case, it is at option 3 (ten nurses). While the average productivity of 15 nurses is the same as that of ten nurses, the marginal productivity actually decreased when five more nurses were added to the nursing pool.

Health Economics Series: Uncertainty and Asymmetric Information

Uncertainty is a situation where it is impossible to know the likelihood (unknown probabilities) of an event occurring while information asymmetry is a situation in which one party has more / better information than the other party.

Many Filipinos exhibit the first type of information failure: uncertainty. Filipinos are not keen on examining the financial implications of contracting a disease/illness. Because of the perceived uncertainty of acquiring the disease and its associated financial repercussions, many Filipinos do not know their need for health care. Two policy responses are widely accepted in the country (social health insurance and private insurance) to help address this. Through these insurance schemes, financial uncertainties directly connected to future disease or disability are minimized.

Information asymmetry is seen in the classic case of tobacco smoking. Smokers usually do not know the addictive properties and health consequences of tobacco use. As such, in 2014, the Graphic Health Warnings bill was signed into law. This law seeks to curb tobacco smoking by providing health information through graphic health warnings in tobacco product packages. The law is the government’s response to information asymmetry happening between tobacco manufacturers and tobacco smokers.

Pen Point 47

Duterte & his allies have mastered the art of deception and selective justice. Deception of people for the sake of the people is a contradiction in democracy. Indeed, politics is a dirty game. Remember that there are no permanent friends, or enemies, only permanent (sometimes selfish) interests.

Inaction is action. Our government is responsible both for the things they do and the things they don’t do, especially when they could choose otherwise. Not until the majority of us choose to side with true democracy, we will continue to fail as a society.

Haven’t you had enough?

Share the road

Due to the COVID-19 pandemic, the public transportation system was paralyzed to limit our mobility. Some government agencies, hospitals, and private organizations were quick to assist medical and non-medical frontliners in their day-to-day travel to and from work by providing other means of transportation such as free shuttle services. Notably, more bike riders are now seen on the streets due to various bike programs. Many of whom are health care workers, myself included.

However, even with the enhanced community quarantine, private vehicles continue to swarm the roads. Some of these vehicles deliberately disobey traffic rules (e.g. beating the red light) which increases the probability of road accidents. This makes it more difficult for bike riders or cyclists to navigate their way to their homes or workplaces.

More health care workers are now opting to walk or ride a bike to work. Thus, it is imperative for the government to reemphasize the importance of respecting traffic rules to avoid unnecessary accidents and deaths. With the growing interest in bike riding and road sharing, we hope to see more bike lanes and road sharing policies in the future to ensure the safety of people choosing alternative modes of transportation in the post-pandemic world.

Burned and scarred

WARNING: This post contains sensitive content which some people may find offensive or disturbing.

Many of us assume that pay and other rewards are all that we can expect to receive from our work. There is less emphasis on less-tangible but equally important benefits like trust, respect, civility, and the opportunity to make a positive change. This view of our work encourages behavior and attitude that lead to employees’ burn out. Thus, contributing to a workplace culture that harms people’s well-being and sense of self.

Over the past years, I’ve struggled with the unprecedented consequences of psychological harassment (also known as bullying). Truth be told, I may not be the only one experiencing this. There are many who might have been blinded to see this kind of harassment as simply ‘part of the job’ or an act of ’keeping the organization intact’. Many of whom would not even know that they, too, are victims.

Our culture and system both cultivated a workplace environment that is punitive, antagonistic, cynical, and perhaps self-serving. Some of you might agree that culture, much like a system, is one that is hard to break or change. It takes considerable effort and political will to accomplish this. However, it is my fervent prayer to see the day that workers get to enjoy working in a workplace that emphasizes the importance of openness, trust, transparency, respect, integrity, and accountability.

It has been months since I began thinking about my next big step. And, the recent burn accident that happened to me while on duty showered (figuratively) me with enough motivation to seek some enlightenment. For now, nothing is definite. But I am only sure of one thing: my conscience is clear. Nothing that I ever did or said intended harm to anyone. My views, opinions, and actions are all in accordance with my personal principles, the ethics of nursing, and the vision and mission of the organizations I am affiliated with.

It saddens me that my pure intention to help, no matter how it is expressed, is often dismissed with prejudice. These preconceived opinions, which I believe are not based on reason, have led to several instances of misunderstanding, manipulation, and most especially misinterpretation. The constant desire to prove one’s worth and sincere intentions has surprisingly taken a toll on me.

Today, I begin to seek ways on how to regain myself. I might be better off seeking fertile soil elsewhere to cultivate my skills and share the fruits I long to offer our society, rather than trying to build a garden in a barren desert. I wish to end the nights of loneliness and self-doubt. I pray that one day I will be able to regain or improve my confidence, well-being, self-worth, and sense of self. Tomorrow, we start the process by going back to the bedside and care for people who currently need us most.

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Disclaimer: Views and opinions in this post are my own. They do not reflect the official positions of the organizations I am currently affiliated with. If the shoe fits, wear it.

WE SHOULDN’T BE SILENCED. WE MUST BE HEARD.

WE SHOULDN’T BE SILENCED. WE MUST BE HEARD.

It is almost always difficult to make a decision. Probably, it is harder during a pandemic when you battle against time and limited resources. Not all administrators will make the right decisions. Not all employees will have the same opinion. What’s common, I suppose, is the collective vision of ending the pandemic at the soonest time possible.

Everyone is afraid, anxious, or worried about dealing with many uncertainties. As a result, everybody is doing all things they can to be saved. Obviously, some *subordinates*, as they call them, would want to be heard. Some people talk in small groups. Some in bigger groups. During a pandemic, it is natural for these people to begin to raise their concerns about how things are being handled. It is common for people to criticize decisions they think are doing more harm than good. It is common for people to propose solutions to problems that directly (or indirectly) affect them.

On the one hand, it should NOT be common and natural for people to blatantly silence critics who are airing valid concerns. Issues, concerns and criticisms are all part of leadership. Rather than thinking of them as bullets attacking or undermining the administration, it is more important for administrators to consider them as challenges. Rather than play the victim, administrators can own criticisms and convert them into opportunities.

Too many administrators get too defensive and choose to focus more on their reputation. They tend to impulsively react and dismiss legitimate issues and concerns, rather than objectively assessing or reevaluating the situation at hand. There have been times when administrators turn the criticism around the person speaking up. They end up chasing the ‘mastermind’ who can easily be blamed, rather than seeing it as an opportunity to learn from someone else. Yes, even from someone among the “subordinates”.

Criticisms are sometimes a clear reflection of poor judgment, but never of character or personality. TAKING CRITICISM IS A DIFFICULT THING. But criticism can always be considered a form of communication – an honest feedback on what transpired after a decision was made. Such feedback can make us stronger by allowing us to listen to honest views that tell us what can be done better. Moreover, TAKING CRITICISM IS UNCOMFORTABLE but it forces us to think about how we work and how we decide. Constructive criticism can guide us away from making poor judgment and subscribing to bad practices.

I believe one of the most important qualities of an administrator is being a good listener. And that applies more when one is being criticized. Don’t always shut them down. Turn up the volume, lend your ears, and listen to what is being said. Be the change agent people want you to be. Turn the negativity into an avenue that enables growth, maturity, and innovation. Turn words into action. Show that you can listen to feedback and at the same time get the job done. Together, let us change the workplace culture of blame. Let us heed the call to become more honest, transparent, and consistent.

Rather than flashing your palm at someone, open up your arms and say…
“I have thought about what you said and this is what I’m planning to do. What more do you think can we do?”