Rising Costs of Healthcare
In the Philippines, the costs of healthcare are rising every year, with 2020’s national cost rising 12.6% from the last year to P895.9 billion. The coronavirus pandemic has also caused extra stress on the healthcare system. There are predictions that it will rise by 14.4% for the 2022 year. Healthcare costs in Malaysia and India are set to rise (as they have in the Philippines) by approximately 16.2% and 23.5% respectively (Royandoyan).
Under the Duterte administration, public healthcare was widely neglected. Beyond healthcare systems increasingly becoming private, Filipino healthcare workers are overworked and underpaid in their own country; a starting salary for a public nurse ranges from Php 22,000 to 23,500 monthly—the equivalent of ~$370-400 USD (Piedad). This leads Filipino nurses to accept job opportunities abroad, therefore further decreasing the number of nurses available. According to the 2020 Human Resources for Health in 2030 report, the Philippine Statistic Authority reports a ratio of one government physician to 33,000 Filipinos, in contrast to the WHO recommended 1:1,000 doctor to patient ratio (USAID HRH2030). Also, the majority of the country’s total health expenditure (THE) of Php 400.1 billion came from household expenses (44.7% in 2020) whereas the contribution of the social health insurance corporation (PhilHealth) continuously decrease their budgets and premium contributions to the THE amounting only Php 133.2 billion in 2020 (14.9%, and 17.8%, 16.6% in the previous years) (Piedad).
PhilHealth membership was associated with 42% greater odds of outpatient utilization and 47–100% greater odds inpatient utilization depending on survey year. Depending on facility type, use of PhilHealth to pay for care was associated with higher average health care costs of 244–865% for outpatient care and 135–206% for inpatient care (Haw, et al.).
The proposed 2023 budget is accused of neglecting direct health services and programs that are accessible for Filipinos. The new government (Marcos Jr) along with the old (Duterte) continued and continue to increase funding for the privatization of health and into the underperforming PhilHealth (IBON Foundation). The Department of Health is also only getting a budget of Php 191.2 billion for 2023. The budget for the Public Health Program was slashed by 8.4% which would effect several disease prevention and management programs, family health, prevention and control of infectious diseases amongst other sectors. The epidemiology and surveillance program and the National Reference Laboratories was also cut significantly (IBON Foundation).
Illness and Mortality
The leading causes of death in the Philippines are diseases of the heart, diseases of the vascular system, pneumonias, malignant neoplasms/cancers, all forms of tuberculosis, accidents, COPD and allied conditions, diabetes mellitus, nephritis/nephritic syndrome and other diseases of respiratory system. Among these diseases, six are non-communicable and four are the major NCDs such as CVD, cancers, COPD and diabetes mellitus (Republic of the Philippines Department of Health).
Specifically in Mindanao, 41.5% of deaths in the Autonomous Region in Muslim Mindanao (ARMM) are caused by non-communicable diseases, 11.8% by communicable diseases, 8.7% by external causes, and 37.9% by insufficiently specifies causes. Ischemic heart disease caused 10.2% percent of male deaths, notably closely followed by assault by firearms at 9.9%, hypertensive heart disease (5.1%), diabetes (4.6%), tuberculosis (4.1%), hemorrhagic stroke (3.1%), chronic obstructive pulmonary disease (2.1%), other diarrheal diseases (1.8%), cirrhosis (1.6%), and lung/bronchus/tracheal cancer (1.5). For female deaths in ARMM, it is led by ischemic heart disease (8.5%), hypertensive heart disease (5.4%), tuberculosis (4.0%), hemmorhagic stroke (3.8%), diabetes mellitus (3.6%), breast cancer (2.6%), asthma (1.9%), other diarrheal diseases (1.8%), chronic obstructive pulmonary disease (1.6%), and neonatal complications (1.4%). Among all regions in the Philippines, ARMM has the lowest Vital Statistics Performance Index Quality (CSPI) summary score which recorded 20.3% and was the only region to record “very low” in tents of CSPI classification (Philippines Statistics Authority).
Health outcomes in Bangsamoro Autonomous Region in Muslim Mindanao (BARMM) are poor — under-five child mortality is twice as high, nearly 40 percent of children under age five are stunted compared to one-third throughout the Philippines, and less than half of pregnant women attended the recommended four antenatal visits compared to 86.5 percent nationally (Oelrichs and Gomez).
Climate Change and Disaster
The Institute for Economics and Peace issued a report in 2019 stating that the Philippines was the most vulnerable country to climate change. By the end of 2022, it is predicted to reach 27.07˚C in contrast to 26.6˚C, 26.64˚C, 26.52˚C of the years prior, respectively (Worldbank). In the Philippines, climate change events include rising sea levels, increased frequency of extreme weather event, rising temperatures, and heavy rainfall. Its normal typhoons and droughts are intensified and bring danger to the climate-sensitive natural resources, and its extensive coastlines that is home to most of the population (FutureLearn). The rising of sea levels in the Philippines are at twice the global average rate with storm surges of up to 15-20 feet. Temperature spikes of 4-5˚C above normal have been recorded in Philippine oceans which damage coral reefs, home to many fish populations, leaving biodiversity and human food resources in a precarious spot (FutureLearn).
Mindanao’s southern islands are also experiencing extreme drought and rising temperatures due to climate change and heightened El Niño-Southern Oscillation effects. In April 2016, a severe drought in Cotabato Province drove thousands of farmers to urban centers to demand food assistance. An ongoing three-year drought is also leading to water rationing in Zamboanga City. In some areas, agricultural land has been rendered unusable. These trends are projected to continue: By 2050, average rainfall is expected to decrease by 11% (De Souza and Spangler).
Bibliography
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FutureLearn. “Everything you need to know about climate change in the Philippines.” FutureLearn, 13 August 2021, https://www.futurelearn.com/info/futurelearn-international/climate-change-philippines. Accessed 28 September 2022.
Haw, Nel Jason L, et al. “Association of SHI coverage and level of healthcare utilization and costs in the Philippines: a 10-year pooled analysis.” Journal of Public Health, 28 November 2019, https://academic.oup.com/jpubhealth/article/42/4/e496/5645101. Accessed 27 9 2022.
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Oelrichs, Robert, and Maria Vida Gomez. “Advancing Universal Health Coverage in the Bangsamoro Region of the Philippines.” World Bank Blogs, 8 April 2021, https://blogs.worldbank.org/eastasiapacific/advancing-universal-health-coverage-bangsamoro-region-philippines. Accessed 27 September 2022.
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Piedad, Maricar R. “Chronically ailing PH public health system under Duterte.” IBON Foundation, 7 April 2022, https://www.ibon.org/philippine-public-health-system-on-the-verge-of-collapse/. Accessed 27 September 2022.
Ramos, Christia Marie. “Nearly 40% of PH's poorest municipalities 'doctorless' — DOH official.” Inquirer.net, 19 June 2020, https://newsinfo.inquirer.net/1294505/2-nearly-40-percent-of-phs-poorest-municipalities-doctorless-doh-official. Accessed 27 September 2022.
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Worldbank. “Philippines Average Temperature - 2022 Data - 2023 Forecast - 1901-2021 Historical.” Trading Economics, 2022, https://tradingeconomics.com/philippines/temperature. Accessed 28 September 2022.
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