A reaction to the Secretary of Health’s speech on the so-called accomplishments of the DoH under the Arroyo administration

By Dr. Edgardo N. Clemente, General and Cancer Surgeon

Upon receiving the speech entitled “A Herculean labor and the triumph of a three-year regime:  the Department of Health under the Arroyo administration”, I was really impressed by such a beautiful title.  Imagine selecting parallels to Greek mythology and comparing the difficult tasks of the DoH to that of Hercules.

Certainly the speechwriter or speechwriters must come from a highly educated and select circle, the type that comprises products of the University of the Philippines.  It is a great honor indeed to be able to present my reaction to the Health Secretary’s speech to this distinguished audience.

I tried long and hard to dig into my college education in U.P. Diliman to find certain lessons and answers that I can use to react, support or demolish the DoH official position paper on its alleged accomplishments.  Since 2004 is presidential election year, the term of President Gloria Macapagal Arroyo may end or if elected to serve another six years, the current Health Secretary may be changed.  In other words, the previously read paper could be the valedictory address of a DoH Secretary.  Should the current DOH Secretary’s appointment extend beyond 2004, then this analysis would cover only the first semester or trimester of his stay in office.

Due to time limitations and lack of expertise on certain areas covered, I would limit myself to giving comments to only a few of the twelve points covered.

Comments on the Introduction – The fallacy of comparing apples and oranges

The DoH starts with the use of the words “achieved major targets, particularly in the health sector”, “its contribution to the quality of life of Filipinos”, and “it contributes directly to the capacity of the human resources in the country by improving the health status of Filipinos, protecting them from excessive costs in attaining desired health and providing client satisfaction.”

To prove its point the DoH speech enumerated the improvements in vital health indicators such as infant, under-five and maternal mortality rates.  While it concedes that the gains were modest, the introduction ends with the words “During its 3-year term the GMA administration is proud to say that it was able to deliver vital services and improve the quality of health in the country”.

Excuse me, I beg your pardon.  Speeches made for a U.P. audience should be well crafted since supposedly intelligent students see through errors in grammar, logic and reasoning.  The speech cited vital health indicators and their improvements from 1990 to 1998 but the coverage of the speech should include only 2001, 2002 and 2003 since the Arroyo administration only took power in 2001.  Remember EDSA II.  Therefore the improvement cited should rightfully be credited to the latter part of the Aquino administration (990-1991) and the whole of the Ramos administration (1992-1998).  Strictly speaking we should even include the Estrada administration since he was President in the second half of 1998.

Nowhere are the cited statistics anywhere near 2001 when President Arroyo assumed office.  The speech should instead use the 2001, 2002, and 2003 statistics if the DoH wants us to believe that indeed there were health indicator improvement during the Macapagal administration.  Such lapse in logic is unpardonable.  This can only be due to a major booboo, intellectual dishonesty, a subtle attempt at credit grabbing or a genuine effort to mislead the public by citing statistics not relevant to the timeframe of the speech in question.

Since the conclusions cited in the introduction are already flawed, I am hoping that the body of the speech is a little bit more grounded in reality.

Point Number 1:  The SARS Scare – Nice try but no cigar

The main argument of the DoH is that it was instrumental in containing the SARS outbreak in the Philippines.  Citing all their efforts to contain the disease, the DoH now claims to the high heavens that, in their own words, their Herculean interventions topped the spread of SARS in its tracks.

Now forgotten is the fact that during the early days of the SARS outbreak, the DoH and the Department of Tourism actually invited foreign tourists to visit our shores because the Philippines was still SARS-free.  This was a naïve call since tourists then in Mainland China and Hong Kong who would have cut short their visits there could have proceeded to the Philippines to complete their overseas vacation trips.  Had some of them been exposed to SARS and were still in the incubation phase and not yet symptomatic, they could have been the carriers of the disease to our country.  Such a misplaced call is unprecedented in the annals of the study of public hygiene and sanitation.  While the error was understandable from the side of the Tourism Secretary due to lack of technical understanding and capacity, for the Health Secretary to blindly follow the then administration line could have resulted in a health disaster.  A lower DoH official was correct in stating that over and above all factors considered, the Philippines was just lucky to have dodged the bullet, in spite of our gross mishandling of the situation.

The audience should also be informed that there were reported major breaks in the manner that isolation techniques were handled in the Regional Institute for Tropical Medicine.  The barangay or barrio that was quarantined also reported  major violations in which the resident under observation freely traveled to adjoining neighborhoods.  The Philippines was lucky indeed.  I just do not know how gross incompetence could be repackaged as a major achievement.  Nazi Germany’s concept that a lie told a thousand times could be mistaken as the truth somehow has a ring of truth in it.

Since the DoH enumerated the SARS Scare as its number one achievement, I can only say that this a classic example of “claiming victories where there are none”.  I just hope we have learned from the situation to the point that when another similar problem crops up we can react better next time.

Point Number Two:  Public Health Reforms – Please define your assumptions

My attention was drawn to the Patak Polio campaign, which in 2002 was reported to have had a 98.8% to 102% success rate.  Such figures are only found in Cuban presidential elections or Iraq when Saddam Hussein was still in power.  U.P. students are trained to be critical in their analysis and a healthy dose of skepticism is part and parcel of an education in natural and biological sciences.

The 98.8% to 102% figure, if left unqualified could only mean that the whole Philippines was adequately immunized for polio probably within a certain age group among children.  A country that has universal protection against polio is certainly one that has to be applauded and praised.  My only problem is that I live in Quezon City with a significant squatter population and huge concentrations of urban poor.  Since I do a lot of walking as an exercise I am able to engage dozens of poor families in small talk in the course of these trips.  Few of them seem to remember any anti-polio medications for their children.  Using the DoH lower value of 98.8% polio vaccination, is it possible that the DoH program missed many children in our city, thus becoming part of 1.2% of children not immunized nationally?  How about children in remote areas where there are no roads, there are ongoing rebellions, and there are no health workers to speak of?

In effect, I am wondering as to what is the target population on which the polio immunization statistics were derived.  Does the DoH mean the whole Philippines?  Does the DoH mean certain targeted communities only, thus leaving significant numbers of our population unprotected from polio?  Assuming the universal polio immunization scenario, then we have nothing to worry about.  If the target population only refers to significant areas identified by the DoH, then there is still much work to be done.  In the meantime, the DoH reaps awards and citations, when in fact if the second scenario is closer to the truth, we may have to adjust our inflated statistics downward or drastically qualify the existing ones.

Point Number 3:  PhilHealth – Degenerating into a political campaign office

The Philippine Health Insurance Corporation Law of 1995 is an improvement over the old 1970 Medicare Law.  The revision was made to further add teeth to the aim of universal coverage.  Since the PHIC Law took effect in 1997, there has been a progressive increase in the membership as envisioned by the new law.  To start with, about six million members of the Social Security System (private sector) and one million members of the Government Service Insurance System (public sector), representing about thirty-five million beneficiaries, formed the initial bulk of PhilHealth.  This figure has progressively increased with the inclusion of individually paying members and subsidized indigent members.  No special call or order was necessary for the PHIC to fulfill its mandate.  The concerted effort of the DoH and PHIC to project a massive recruitment program is premised only on the ability to churn numbers for public relations consumption.  During this presidential campaign, PHIC cards are given away to indigents in an attempt to entice them to vote for the incumbent president.  This is very obvious with the GMA cards that stand for Greater Medicare Access, a play on the presidential initials.  To emphasize my point of a political agenda, the picture of the sitting president is prominently displayed in the PHIC indigent cards.  This campaign gimmickry and antics are cheap tricks to generate votes come May 10.  The basic problem with this is that the PHIC should be insulated from politics so as to maintain its character as a professional organization.  The blatant attempt to float the figures of 5 million family beneficiaries involving twenty-five million people are numbers that are picked out from thin air but may give potential voters some hope and therefore translate to votes for the administration.  The administration shows signs of panic and desperation when they have to project progressively higher quantitative targets that they need not even have to fulfill should they be kicked out of office in May.

Point Number 4:  Half-priced medicines – Buy them from your newspapers

In my columns from the Business World, I have always emphasized my support for government moves to lower the prices of medicines.  The parallel importation program espoused and piloted by the Department of Trade was and still is a step in the right direction.  While it is true that massive importations of life-saving drugs can depress the prices in the market, the DTI importations amounted to only to hundreds of millions of pesos while the annual Philippine gross sales is in the more than sixty billion pesos a year level.  In other words, the DoH is able to monitor the reduction in prices only while the stocks are in the market.  Once the newly imported stocks are consumed, the drug prices manage to get up again.  So while it is true that the DoH and DTI were indeed able to show that the prices of medicines can come down, the volume of imports is so small compared to the total needs that the drop in medicine prices are transient and temporary.  As the saying goes, “Buy them while the supplies last”.  Unfortunately overall most drug prices have gone up within the last three years brought about by the depreciating peso since most medicines or their components for manufacture are imported.

The DoH has started to believe their own press release sin an effort to claim still further victories during their watch.  The operational law here is nothing but the Law of Supply and Demand and since the DoH/DTI efforts are minimal, the small drops in prices that they are able to monitor are soon overwhelmed by the realities of increasing energy, labor, transportation and other costs on top of rising inflation and depreciating peso.  Discerning consumers laugh at DoH statistics.  Since most of the low priced medicines are only read in the newspapers but seldom seen in the real market place, the joke is for the buying public to purchase their medicines from the newspaper offices.

Point Number 5:  Family Planning – A policy of abdication

The cute administration of President Arroyo came up with what it considers a Solomonic solution to the family planning problem, a truly contentious issue indeed.  Called natural family planning, the program goes to the root causes of poverty and unemployment to solve the rise in population that has gone out of control.  Any high school student who has taken up what during our time was called social studies knows that.  The very lessons of Mathus are that the rise in population is geometric while the increase in available resources is arithmetical in progression.  The very essence of the family planning program is to buy time by reducing the number of mouths to feed.  In truth, the current DoH family planning program is a cop-out.  The DoH does not have to do anything about controlling the population since resolving the poverty and unemployment issues would ultimately solve the population problem.  As if poverty and unemployment can be solved without reducing the population rate increase.  I believe the underlying reason for the DoH soft stance on population planning is to avoid a frontal clash with the powerful Catholic Church.  In allowing the government’s family planning program to wither in the vine, the DoH showed weakness, indecisiveness and lack of firm leadership.

Point Number 6:  Hospital Reforms – Killing them softly

The number one problem of most Philippine hospitals today is how to deal with the government bureaucracy specifically PhilHealth red tape.  Hospitals and PHIC patients spend billions of pesos trying to comply with fluctuating rules and regulations when filing for PHIC reimbursements.  Paper requirements in the form of birth certificates, payment records, hospital bills, employment status and the like keep an army of PHIC reimbursement hopefuls shunting from their places of work, hometowns, hospitals and PHIC offices in the never ending task of trying to comply or fulfill the fickle requirements needed to file a hospitalization reimbursement claim.

In closing I agree with the Health Secretary’s speech on the “Herculean labor” part of the title but I would certainly dispute the use of the word “triumph” in that same title.  Using “mediocrity” or “making a mountain out of a molehill” would have been more appropriate.  I read the speech over and over and really tried to look for the so-called accomplishments but I have yet to find them.  Of course, I appreciate the reference to Hercules, it was really highly informative.  So as not to leave the audience with a feeling of emptiness with regards to some literary masterpiece, I have brushed up on my Shakespeare to come up with an appropriate quote for the occasion.  With your permission, I would like to entitle this piece, “Much Ado About Nothing”.

Thank you.