Health populism

Medical missions with free checkups, free medicines and, who can forget, during summers, “libreng tule” (free circumcision)?

Traditional politicians have long recognized the power of health populism — catering to the health-related needs and wants of people to bring in votes and build a political base. President Duterte, the consummate populist, and his right-hand man and now newly elected senator, Bong (Christopher Lawrence) Go, are well aware of the power of health populism. This came through clearly on Monday during the 2019 State of the Nation Address, when the president “reminded” the new senator to fulfill election promises, specifically citing additional benefits for solo parents, assignment of health workers to all barangay centers and the expansion of Malasakit Centers.

The Malasakit Centers caught my attention briefly at the height of the election campaign, when the Commission on Elections ordered that Go’s campaign posters be taken down from such centers, including at the Philippine General Hospital.

So, what are these Malasakit Centers?

We’ve all heard of stories of medical indigents having to run to relatives and friends for help, and then to the Department of Social Welfare and Development, the Philippine Charity Sweepstakes Office and Pagcor (Philippine Amusement and Gaming Corp.)… and to their mayors.

As mayor of Davao City, Duterte established a one-stop center under his office to spare the indigents from having to go to so many agencies, each with their own bureaucracies. That was a clever populist move, because indigents now “owed” the mayor, rather than the other agencies.

After Mr. Duterte became president, his strategists, probably Go, saw the importance of doing something similar on a national scale. Plans for Malasakit Centers were announced as early as 2017, but a formal launch did not happen until September 2018. It is not clear just how many Malasakit Centers there are now —I was able to find a news article about the inauguration of a 31st Malasakit Center in March 2019. The centers process the indigents’ concerns and cover up to P50,000 per case.

Politicians and advertising people are experts when it comes to tapping the power of words. “Malasakit” is actually an abbreviation of “pagmamalasakit,” to be compassionate. Note, too, how “sakit” (illness, to be sick) is the core of this term. The height of compassion is to be able to offer support to someone who is sick.

These Malasakit Centers are real and palpable for the poor, and so it is not surprising that Go has already filed a bill in the Senate to institutionalize these centers.

Now, contrast the Malasakit Centers with the universal health coverage law passed in February this year. This new law automatically enrolls all Filipinos in a National Health Insurance Program, and will supposedly improve access to health care. You would think such a comprehensive law would have gained votes for its main sponsor JV Ejercito, who in fact reminded people about his advocacy for health legislation in all his posters as he campaigned for reelection.

He didn’t make it.

Here we have a clear case study on health populism as a political tool. The Universal Health Care Act sounds good, but its implementing rules and regulations have just been drawn up, and look very complicated with new bureaucracies and procedures.

In contrast, the Malasakit Centers are up and running and have immediate impact on the poor.

But if the Malasakit Centers highlight the power of health populism, they also show its limitations. The centers are a stop-gap, leaving untouched the many reasons why the poor can’t afford health care in the first place.

Health populism often misses out on the power of mobilizing people, particularly through the strengthening of health care services at the barangay or primary health care level. The most vital health services aren’t to be found in hospitals and sophisticated equipment; it comes with an empowered citizenry that gets health education, immunization, water and sanitation.

But even where primary health care is strong, still untouched are the problems of not having jobs and money for food and shelter. Our current populist government treads a delicate balancing act by offering Band-Aids for health even as it prepares for a new round of taxes under TRAIN which, ironically, will mean even more money for the health sector. The Department of Health and PhilHealth are already awash with funds, but the money just isn’t going to the right programs and, worse, seem to be plundered.

Which means the Malasakit Centers will be around for a long time, its main beneficiaries being the politicians.

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