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Addressing Health Human Resource Gaps in the Philippines

Addressing Health Human Resource Gaps in the Philippines. Tony Leachon , MD Philippine College of Physicians Foundation Coalition for Primary Care May 4,2016. Disclosures. PhilHealth , Independent Director as Representative of the Monetary Board President, PCP Foundation Inc.

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Addressing Health Human Resource Gaps in the Philippines

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  1. Addressing Health Human Resource Gaps in the Philippines Tony Leachon, MD Philippine College of Physicians Foundation Coalition for Primary Care May 4,2016

  2. Disclosures • PhilHealth , Independent Director as Representative of the Monetary Board • President, PCP Foundation Inc. • Member, Coalition for Primary Care • References : Research work of Dr A.Dans, DOH,PHIC , PCP, PSGIM, AER, Coalition for Primary Care

  3. Agenda • Background : Philippine Healthcare • UHC : Where are we now ? • Healthcare Workforce Crisis • Recommendations : • Primary Care system • 5 R’s • Summary

  4. 47.6% of deaths among Filipinos are unattended by a medical doctor or allied health provider.

  5. Health Human Resource, Philippines. 1 PRC database, 2014 2 Philippine Statistical Yearbook, 2010. 3 Total 2.3 HCW’s/10,000 pop; WHO recommends 24/10,000.

  6. Supply of Health Care Workers’ is Decreasing • We are #1 exporter of nurses • We are #2 exporter of doctors • ASEAN integration will open doors.

  7. Top 10 Causes of Mortality, Philippines 2010 Number affected Rate per 100,000 Cause of Death 1. Diseases of the Heart 102,936 109.5 68,553 72.9 2. Diseases of the Vascular Sy stem 3. Malignant Neoplasms 49,817 53.0 4. Pneumonia 48.5 45,591 5. Accidents 36,329 38.6 6. Tuberculosis, all forms 24,714 26.3 7. Chronic Lung Disease 22,877 24.3 8. Diabetes Mellitus 21,512 22.9 9. Nephritis/nephrotic syndrome/nephrosis 14,048 14.9 10. Perinatal disease 12,086 12.9 Philippine Health Statistics, 2010

  8. Double Burden :3 Chronic Problems • 1.Chronic healthcare workforce shortage • PH # 1 exporter of nurses, and the number 2 exporter of doctors in the world.  • This shortage is at its worst where healthcare workers are needed most – in rural and urban public facilities, where they are both underpaid and overworked. • 2. Fragmentedsystem • characterized by 46 separate but overlapping healthcare programs driven by donor initiatives rather than population needs.  • This has hindered our ability to integrate, harmonize and prioritize solutions to problems in health. • 3.Healthcare system is also fragmented administratively, with local government units placed in charge of frontline healthcare delivery.   • This has politicized the healthcare workforce and has made it difficult for the DOH to orchestrate a unified healthcare program.

  9. Universal Health Care(UHC)Inaugural Address 2010 • “Provision to every Filipino of the highest possible quality of health care that is accessible, efficient, distributed adequately funding, fairly financed, and appropriately used by an informed and empowered public." • It is also known as KalusuganPangkalahatan, which the Aquino administration describes as the "availability and accessibility of health services and necessities for all Filipinos."

  10. Universal Health Care(UHC) Republic Act 10606 • A government mandate aiming to ensure that every Filipino shall receive affordable and quality health benefits and services such as : • Human resources • Health facilities • Health financing

  11. One Peso DOH Consultant 2011-2013

  12. Sin Tax Law Signing Dec 20, 2012

  13. 2003 2013 PhilHealth Utilization PhilHealth Utilization Income Income Poorest 18% Poorest 33% Poor 23% Poor 71% High Middle 48% 24% Middle Low Middle 54% Rich 28% Rich 70% Richest 33% Richest 88% NDHS 2003 Faraon et al, 2013

  14. Pneumonia Hemodialysis Infections (UTI) CS / Cataract P H I C Are patients benefiting? • Out-of-pocket spending remains high at 57% • The top conditionspaid by PhilHealth do not matchpriority health conditions and are focused on costlyinterventions

  15. Sin Tax Funds to PhilHealth • Republic Act No. 10351 (or the Tobacco and Alcohol Tax), signed by President Aquino on Dec. 29, 2012 • gives the government the financial capacity to cover the full subsidy of the premium coverage of 14.7 million poor Filipino families (or more than 45 million Filipinos), amounting to P37 billion for 2015 and an increase of the Department of Health budget to P103 billion (an increase never received before). DOH Sec Enrique T.Ona , PDI July 2015

  16. What the Sin Tax Law has already achieved 150 Php in 2015 • Revenue generation

  17. Prevalence of Never, Current and Former Smokers. Philippines, NNS 1998-2015 Prevalence (%) 70 63.7 Never Smoker 59.1 60 55.0 54.5 54.3 50 Current Smoker 40 34.8 32.7 31.0 25.4 30 23.3 20 Former Smoker 15.5 10 14.7 13.0 12.8 10.2 0 1998 2003 2008 2013 2015

  18. Sin Tax Law Health Updates NNS 2015 • Prevalence of smoking among adult Filipinos went down from 31.0% in 2008 to 23.3% in 2015. This means there are ~4 million less smokers in the country today because of the Sin Tax Law. The drop is not from people who stopped smoking. It is from people who avoid starting to smoke. At least 70,000 deaths have been averted since 2013. Health benefits were greatest in price sensitive populations – the poor, rural folk, the very young and the very old.

  19. Strategic QuestionsHow Doctors Think • 1.Where are we now ? Diagnosis ? State of The Nation’s Health • 2. Where do we want to go ? Towards UHC • 3. How do you get there ? Eg Plan of Action

  20. Where are we? (The Philippine Healthcare System)

  21. Good News and Bad News about the Philippine Health Situation • PhilHealth coverage has increased from 51% in 2010 to 88% in 2015 (PhilHealth) 1 • But PhilHealthutilizationremains low, especially amongst the poorest (only 33%) 2 • The health budget increased from PhP28.7B in 2010 to PhP205B in 2015 3 • But the number of Filipinos who die without seeing a HCW increased from 45% to 66% 4 • We are the number 1 exporter of nurses in the world 5, and the number 2 exporter of doctors 6 • In the public sector, • There are only 5 HCW’s per 10,000 population (ideal = 25) • There is only 1 doctor per 20,000 (ideal = 20) 7 • 1Philhealth, 2Faraon et al, 2013, 3 Department of Health, 4 Philippine Health Statistics, 5Matsuno et al, 6 World Health Organization, 7Dans et al

  22. Why healthcare workers leave 1 • Unemployment (unfilled positions for HCW’s) • Underemployment (underpaid for workload) • Misemployment (job orders and casuals) • Unjust working conditions (eg - politicalization of appointments, non-issuance of magna carta benefits) Why healthcare workers stay 2 • To serve the country • To be with their family 1 Ebesate J, 2012, 2 Lorenzo M, 2005

  23. Where do we want to go? (Ideally ,A Primary Care System)

  24. The Philippine Healthcare Situation Too Little Health Care Too Much Health Care Mr. Jose 42 years old From Busuanga - High Blood - Diabetes - Tuberculosis No consultation No medications Mrs. Rosete 50 years old From Quezon City - Diarrhea (gastro) - Stroke (neuro) - High Blood (cardio) - Diabetes (endo) - Kidney ds (nephro) - Gout (rheuma) - Pneumonia (pulmo) 66% of deaths among Filipinos are not attended by a doctor, nurse or midwife PHS 2011 1.5M families a year pay for catastrophic health expenses. Ulep et al 2013

  25. A Primary Care System 1° CARE 2° CARE 3° CARE ALLERGIES HEART DISEASE SKIN DISEASE INTESTINAL DISEASE BLOOD CONDITIONS INFECTIOUS DISEASE WOMEN’S HEALTH PREGNANCY CANCER LUNG DISEASE SURGERY BRAIN DISEASE KIDNEY DISEASE

  26. INEQUITY IN HEALTH INADEQUATE WORKFORCE INADEQUATE FACILITIES INADEQUATE TESTS/MEDS THE PROBLEM Funds have increased but services have deteriorated

  27. PRIMARY CARE OUTPATIENT PACKAGE PHILHEALTH FUNDS FOR WORKFORCE (AT THE FRONTLINES) FUNDS FOR FACILITIES (AT LGUs, RHUs) FUNDS FOR TESTS & MEDS (PREVENTIVE CARE FINALLY) THE PROPOSAL Healthcare SYSTEM reform: Tunayna KP!

  28. A Primary Care System A Healthcare System that enables patient access to healthcare providers with 3 main functions: Primary Care Provider 1. FIRST CONTACT & COMPREHENSIVE CARE Patient 3. PRINCIPAL POINT OF CONTINUING CARE 2. COORDINATOR OF HEALTH SERVICES Laboratories Pharmacies Specialists Facilities

  29. How do we get there? (How to Reform the Healthcare System)

  30. Roadmap to a Primary Care System RECRUIT RETRAIN RETAIN REGULATE REASSESS • Threshold density 5:1000 (WHO) • Graduate doctors, nurses, midwives • Current practitioners • Private & Public sector

  31. Roadmap to a Primary Care System RECRUIT RETRAIN RETAIN REGULATE REASSESS Workshops on DOH priorities: - Infectious Diseases - Non-Communicable Diseases - Health System Navigation

  32. Roadmap to a Primary Care System RECRUIT RETRAIN RETAIN REGULATE REASSESS • Pay for outpatient care! • In public sector – provide and augment salaries of HCWs • In private sector, subsidize payments for healthcare.

  33. Roadmap to a Primary Care System RECRUIT RETRAIN RETAIN REGULATE REASSESS Facility – electronic records Health workers – accreditation Patients – require primary care

  34. Roadmap to a Primary Care System RECRUIT RETRAIN RETAIN REGULATE REASSESS • Better Quality of Care • Better health • Reduced healthcare expenses • Reduced out of pocket payment

  35. Roadmap to a Primary Care System RECRUIT RETRAIN RETAIN REGULATE REASSESS

  36. Summary • Despite the rising budget and increasing Philhealth coverage, healthcare is deteriorating. • The deterioration is mainly due to a shortage of healthcare workers caused by massive  migration • Healthcare workers who stay (especially those in rural areas) are patriots who want to serve the country. • The government need to take better care of those who care for our health. • Primary care is vital in achieving genuine UHC. Walangkalusugangpangkalahatan, kung walang mag-aalagasataongbayan! – Coalition for Primary Care

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