Almost every day I see patients (or their relatives) looking for stretcher beds as there are no longer available beds in the emergency room. This scenario, I suppose, will persist even when hospital renovations are finished this year. While increasing the hospital’s bed capacity potentially decreases waiting time for patients, no amount of beds will ever suffice. The neverending influx of patients in the Philippine General Hospital is a result of the increasing demand for health care among poor Filipinos amidst rising health care costs. The same is true, or even worse, for other government hospitals.
PGH is a microcosm of the Philippine health care system. Our experiences in this hospital mirror big challenges that the country will continue to face while implementing the universal health care law. First, poor gatekeeping at the primary care levels will allow patients to seek care at higher level facilities even when lower level facilities are capable of handling their medical conditions. This, coupled with patients’ poor confidence of primary care health workers, encourage them to flock in tertiary level facilities which results in overcrowding.
Second, chronic lack of manpower and other resources delay necessary care. Patient waiting time is high for common radiologic procedures (e.g. x-ray, ultrasound) because there are only few machines available for hundreds of patients. Nurses, faced with high patient workload, leave out essential care elements to meet only the urgent physiologic needs of their patients. Our study on nursing care rationing in PGH showed that 45% of nurses kept a patient who rung for a nurse waiting longer than five minutes. More than half of respondents disagree that there are enough nurses to get the job done or to provide quality care. More than half of nurses also reported a physician did not come or took a long time to arrive after a call.
These are few of the challenges that patients and health care workers in PGH continue to face. While we strive to be a model of health care delivery, our current set up is far from what we all have dreamed of – a hospital that transforms lives through excellent care, education and research. I cannot imagine how other hospitals and health workers deal with poorer work conditions.
The road to UHC is quite long. PGH is a reflection of the government’s failure to adequately lay concrete interventions that will make our journey smooth. Gatekeeping at the primary care level and provision of adequate human resources for health are two key elements that will drive the realization of universal health care.
In poor countries such as the Philippines, where labor is cheap and work conditions are poor, the need for subsistence often takes away an individual’s capacity to choose.
It has been a great year. I cannot thank enough the people who have been part of this amazing 2019!
In the past, I wrote top lessons I learned during the year. For this year, I will have to put them aside and share with you nine questions I had in 2019 that remain unanswered (or partially answered). I hope to find answers in the coming new year.
- Can the healthcare system achieve both equity and efficiency at the same time? Or are the two concepts contradictory in healthcare? Should one be achieved before the other?
- How can we make the procurement process be more flexible and less corrupt while being strict on the quality of materials procured?
- What incentives could eventually reconcile self-interest and social interest?
- Should state-funded health care be rationed? How should the government ration health care to meet the current demand? How does rationing of care contribute to universal health care?
- Does the current national social health insurance program increase or decrease the efficiency of the use of scarce resources? Is ‘access’ rather than ‘utilization’ of health services a better measure of equity in health care?
- Do patients’ preferences affect the supply of health care services? Or are variations in the supply of health care services in various settings simply a response to high levels of patient demand? If not, how much do patients’ preferences contribute to utilization of health care services?
- How do we go about the Filipino culture of putting too much trust on one’s doctor to the extent that we lose exercising our right to participate in decision-making?
- Do we cast our nurses as “global goods” rather than “domestic providers” of health care, implicating them as sources of remittance income rather than for their potential contributions to the local health system? Is this kind of trade (trade in health services/providers) not only motivated by the desire for revenue, but also by the desire to cope with overproduction and lack of opportunities for nurses in the Philippines?
- Do people’s preferences and tastes change in situations where there are very few choices? Or do they develop an acquired taste/preference because of limitations posed by societal inequities?
We don’t usually depend on what others say about us or how they see us because we need to own our truth. But, up to which point do we continuously neglect the truth, as perceived by others? They, too, are mirrors to our truth.
The moment we deny ourselves the truth is the time we succumb to lie and deception.
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.
How much is the price of upholding the rights of nurses in the country? For some, it costs nothing.
Nurses are at the frontline of the health care delivery system. They become the first and last health workers in contact with patients and their families. As such, nurses are exposed to low- and high-risk hazards during their working hours. Exposure to these hazards could result in discomfort, illness, and even death. It is imperative, therefore, to provide additional compensation to nurses performing their jobs in hazardous work areas.
Through Republic Act No. 7305 or the Magna Carta of Public Health Workers, the State recognizes the need to provide extra compensation to nurses for performing duties that expose them to potential health hazards. However, recent reports slap us with the reality that some nurses in the country receive little to no hazard pay.
We aspire for fair and adequate hazard pay for nurses in the Philippines. Fair in the sense that all nurses are well-compensated considering the health risks associated with the nature of their work. Adequate in the sense that it follows the rates set forth by the law. Fair and adequate hazard pay ensures the protection of nurses who relentlessly offer their lives to the service of the people. Fair and adequate hazard pay puts premium on the lives of both the health care workers and the patients they serve.
While we recognize the financial limitations being experienced by many local and provincial government units, this should not restrain the government from exercising its lawful duty to protect health workers from the dangers associated with the delivery of health care.
I call on the Department of Health (DOH) to look at the undocumented issues surrounding the non-payment of hazard pay experienced by nurses in various parts of the country. Moreover, I call on the local and provincial government units to (1) review its annual budgetary allocation and bring back health at the top of its priorities and, (2) ensure that nurses are compensated hazard allowances equivalent to the appropriate percentages as specified by the law. Finally, I call on Congress, DOH and the Department of Budget and Management to revisit the Magna Carta for Public Health Workers, specifically the provisions on salaries, hazard pay, and other forms of allowances.
The right to health is not limited to a privileged few. The government carries the burden of ensuring that this right is upheld as a human right equally enjoyed by all Filipinos. The promises of universal health care cannot be realized when the primary drivers of the health care system, our health care workers, are left at the brim.
Given adequate information, the market theory assumes that consumers know what is best for themselves; hence, they make choices that maximize their total satisfaction. If this assumption is wrong, markets may not efficiently produce. We call this satisfaction consumers gain from consuming a good or service as “utility”. The satisfaction (or utility) depends on the quantity and mix of goods and services chosen by a consumer. The theory holds that consumers get more satisfaction from more goods and services but the increase in satisfaction from consuming additional units gradually diminishes. In health care, how do consumers go about choosing the mix of goods and services which give them the maximum total utility? In places where there are few sources of health care goods and services, do people take into account their tastes/preferences and income when choosing a combination of goods and services which gives the people the highest utility? Do people’s preferences and tastes change in situations where there are very few choices? Or do they develop an acquired taste/preference because of limitations posed by societal inequities?
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.
Sahod ng nurses, dagdagan! Dagdagan!
We have the money. But we also have politicians who are in their “right” minds to know what/who to prioritize: their selfish interests. Never the country nor their countrymen.