Public health challenges for 2020 (Part I)

This year has been very eventful for public health in the Philippines. In February, amid much fanfare and anticipation, the Universal Health Care Act (Republic Act No. 11223) was passed — a culmination of a series of health-related legislative measures over the past several years, from the sin tax law (RA 10351) to the new HIV/AIDS law (RA 11166), that many hope would transform the health care system. We also saw health figure in the 2019 elections as part of several candidates’ campaign platforms, with varying degrees of depth and substance.

Yet if 2019 saw a lot of attention toward health, it also served to illustrate the serious challenges that need to be hurdled if “health for all Filipinos” — and not just universal insurance coverage—is to be achieved. As we face a new year, it is a timely exercise to enumerate some of these challenges:

Vaccine-preventable diseases. Early this year, a measles outbreak claimed the lives of over 560 Filipinos; several months later, the re-emergence of polio—a disease that has been documented in the country for decades—was announced. What the two diseases have in common is that they are actually preventable through vaccines. The same can be said of chickenpox, mumps, pertussis, for which doctors are also sounding the alarm.

To its credit, the Department of Health has strengthened its immunization efforts, including awareness campaigns. In a reversal of what happened during the dengue vaccine scandal, I have seen families lining up in rural health centers to get their children vaccinated in the wake of the measles outbreak. Still, if 2020 is any different from 2019, families should be motivated not by fear but by knowledge and trust. Crucially, supply-chain issues should be addressed and public officials should be held accountable both for vaccine-related corruption and misinformation.

Dengue and tuberculosis. The dengue season this year was particularly devastating with, as of last month, over 350,000 cases and 1,300 deaths, prompting the declaration of a “national dengue epidemic.” Receiving far less attention but no less significant, tuberculosis—the “boring emergency”—continues to plague the country, with an estimated 591,000 cases and 26,000 deaths last year alone, earning for the country the unwelcome distinction of ranking fourth globally in terms of TB incidence.

While much of the public’s attention concerned the dengue vaccine, the nature of the disease means that it will require various actions from the personal to the national level toward primary and secondary prevention—that is, mosquito control as well as access to quality outpatient, emergency and inpatient care.

As for tuberculosis, Health Secretary Francisco Duque’s call for “not business as usual” last year at the United Nations must be renewed, with particular attention given to strengthening the role of primary care (including barangay health workers) in following up patients, rethinking the “directly observed treatment, short-course” program, and enhancing coordination between public and private health care providers.

HIV/AIDS. Despite increased public attention and the welcome visibility of people living with HIV (PLHIV), the infection remains on the rise, even as efforts toward promoting condom use and increasing testing remain inadequate. In absolute terms, HIV incidence remains low, with the UNAIDS estimating a country total of 77,000 cases. However, the rate of increase—174 percent over the past decade—is among the highest in the world. Moreover, while the national incidence is relatively low, it is much higher in certain populations.

Unfortunately, buried in the stigma and lack of information is the fact that HIV is both preventable and manageable. But we need to remove cultural, economic, bureaucratic and physical barriers to enable access to comprehensive education, confidential testing, antiretrovirals and pre-exposure prophylaxis—including for minors. RA 11166 addresses these concerns, but the government should strive for their full implementation if we are to arrest this trend.

Next week, I will discuss three other challenges that will require much attention and action in the coming year: malnutrition, noncommunicable diseases and mental health.

[glasco@inquirer.com.ph]