With 23,395 barangay health stations, 2,722 birthing homes, 2,599 regional health units, and 1,385 hospitals all over the country, healthcare facilities are hardly sufficient, especially at the barangay levels, to cater to the immediate needs of the people.
As of December 31, 2021, there were 816 level-1 hospitals in the Philippines, 120 of which were located in Region 3. In contrast, CARAGA had 13 level-1 hospitals as of this date.
As of December 31, 2021, there were 335 level 2 hospitals in the Philippines, 54 of which were in Region IV-A. In contrast, there was just one Level 2 hospital in the BARMM (Bangsamoro Autonomous Region in Muslim Mindanao).
In total, there are about 1800 hospitals in the Philippines, of which 721 (40 percent) are public hospitals; the DOH directly operates 70 of them.
Even before the current pandemic, the Philippines was already facing a serious shortage of medical workers. Based on the most recent data from the Department of Health there were 40,775 medical doctors (in the health sector) in the country in 2017, which translates to a medical doctor-to-population ratio of 0.4 HCW for every 1,000 people.There are 45,903 dentists.
Three levels
General hospitals are classified into three levels — Level 1 with minimum healthcare services, Level 2 that offer extra facilities like intensive care unit and specialist doctors, and Level 3 hospitals that have training programs for doctors, rehabilitation, and dialysis units, among others
Given the standard ratio of 1 HCW to 20 households this compromises the health service delivery at the barangay level, where most of the vulnerable groups of the population are situated. The inadequacy leads to delays in implementing health programs.
A barangay health center is a community-based facility whose goal is to offer first aid, maternal and child health care, communicable diseases and other basic health services to all the constituents of the barangay.
For Metro Manila, 72 percent of all its hospitals are privately-owned. Bulk of the beds in the whole country is concentrated in this region. Also, a large proportion of Level 4 hospitals are in Metro Manila. Quezon City has the biggest number of hospitals, while Valenzuela City and Pateros do not have any.
The barangay health centers are usually understaffed, and medicines (the first source of physical remedy for people) are hardly available.
Medicines are always out of stock
It is particularly difficult for poor people on maintenance drugs during a coronavirus pandemic to cope with their ailments since visits to local health centers were limited (if not totally restricted) during the pandemic.
Primary care, which focuses on prevention rather than cure, is supposed to provide wider coverage and prevent social disparities in healthcare, apart from reducing the financial burden on the public health system.
Health advocates complain that people are unaware of its benefits and government health centers are few and far between, not to mention the lack of funds to run them properly, said a story on Philippine Star.
No oxygen tanks
“There are no oxygen tanks at the local health center,” Becky S. Barrios, who heads a civic group that helps the Manobo tribe of Agusan del Sur in southern Philippines, said in reply to emailed questions. “Medicines are incomplete. Losartan and other hypertensive drugs are usually out of stock.”
Primary healthcare, which should address 80 percent of a person’s health needs, is unlikely to succeed in a country that struggles to allot sufficient budget for its citizens’ health, she said. “Local villages lack the facilities to treat people,” she added, noting that there’s only one midwife for every barrio.
Indigenous people have also been hesitant to visit health centers for fear of being declared coronavirus positive in an antigen test, Barrios said.
Half of Filipinos don’t have access to a nearby primary care facility — one that patients can reach in 30 minutes, according to the Department of Health (DoH). The Philippines had 216,841 community health workers, based on government data from 2010.
Many of these workers are concentrated in poblacions, said Ellen Dictaan-Bang-oa, a coordinator for the indigenous women program of Tebtebba, a local resource center in Baguio City in the country’s north. “This is a challenge in cost, time and access especially for those in remote villages.”
In 2019, Tebtebba started a dialogue among indigenous youth and government agencies, where they discussed the need to build more health centers, hire more health workers and make them more culturally sensitive.
There was also an initiative to integrate indigenous birth attendants into the local healthcare system in Mindanao and Mindoro, Dictaan-Bang-oa said.
SPECIALISTS
Protecting medicinal knowledge is also an enduring concern, she said. Some local governments have issued ordinances to criminalize the practice of indigenous healers.
“Indigenous peoples visit baylans or traditional healers if they believe their illness is caused by spirits,” Barrios said.
A baylan’s rituals include offering eggs and candles, using herbal medicines such as turmeric and moringa to treat stomach aches, urinary tract infection and other illnesses.
Filipinos usually consult specialists when they’re sick, betraying the country’s bias for a curative-, hospital- and doctor-centered service, said Magdalena A. Barcelon, president of the Community Medicine Practitioners and Advocates Association.
This healthcare model, patterned after that of the US, has led to expensive medical care in the Philippines, and specialists end up treating illnesses that primary care doctors could have easily managed.
Welcome development
“Prioritizing the role of the barangay in the healthcare system is a welcome development for us,” Barcelon said, because the primary stakeholders are the people in the basic unit of the social infrastructure — the grassroots community, which consists of the barangay.”
Their group envisions primary care in which people can decide about their own nutrition, sanitation and other health concerns.
Health centers in the countryside should keep vital services in the peripheries because of their limited capacity, Raul S. Ting, a doctor and community health advocate from Tuguegarao City, said in an online forum in September.
He had helped rural health units get coronavirus disease 2019 (COVID-19) supplies through his volunteer contacts. Among the beneficiaries were ward nurses who used to buy their own face masks and birthing units that were given disinfecting UV sterilizers.
Helping RHUs
“Last year’s work evolved into helping out rural health units because either the local government unit couldn’t afford to budget more for health services, or it was not among its priorities,” he said in a Messenger chat, noting that some cities only act if there’s income to be earned.
Letting the National Government enforce healthcare services would improve these facilities, Barcelon said. The poorer the local government, the sadder the state of healthcare in the area, she pointed out.
Republic Act No. 11223 or the Universal Health Care Law mandates a healthcare system that focuses on prevention.
But for primary care to really work, people must be health literate, according to Christian Edward L. Nuevo, DoH’s chief health program officer for disease prevention and control. Primary care facilities also must be expanded, he added.
Barcelon said primary care at the community level could boost rapport between health workers and patients.
“A rural health doctor can monitor a patient from infancy onwards,” she said.
Rivassaid free medicines from the health center are a big help to cash-strapped Filipinos like her.
“But I feel like I have to beg for them. It doesn’t feel right.”
There is a big difference between urban centers and remote areas, echoed by a stark contrast in poverty incidence. Hospitals are mainly clustered around Metro Manila, and smaller clusters appear in cities like Cebu, Iloilo, and Davao.
The disparities between urban and rural centers are huge. In Metro Manila, the average city center is 660 meters away from a hospital, and the top 10 most populated provinces (2015) average 6.36 km. As for all other municipalities, the nearest hospital is 13 km away on average.