Jolted by the coronavirus

The COVID-19 pandemic has caught the country’s health system off-guard. Several doctors have died, health warriors brave the frontlines sans good protective gear, test kits race against the exponential increase of PUIs, and hospitals brace for a torrent of patients.

Health authorities had a three-month window to prepare a war plan when China was mounting a “people’s war” on the deadly coronavirus from Wuhan. But it was only in mid-March when a lockdown in Luzon and a state of national calamity was declared. Only on March 30 was the health department in full gear, with sub-national labs rolled out and thousands of PCR test kits flown to regional health units.

Why was the country ill-prepared and ill-armed to face an epidemic that has forced human activity to a halt?

Recent scientific studies should have served as a wake-up call to the country’s health authorities. Last week, the Coalition for People’s Right to Health said the country scored 0, or was ranked low or an underachiever, in infectious disease preparedness, public health emergency, and health care system, citing the reports of Rand Corp., the Johns Hopkins School of Public Health, The Economist, the World Economic Forum, and the medical journal The Lancet.

In 2017, the Council for Health and Development (CHD) published a report on the country’s health system, reiterating an appeal in 2016 that health should be on the President’s agenda. The CHD revealed that 61 percent of barangays have no health stations while current ones are handicapped by lack of personnel, medicine, and equipment. This abject state deprives the masses of preventive and promotive health like immunization against infectious diseases. The health department and local units are short of 26,000 health personnel, including nurses. An air ticket to other countries is the low-paid health professional’s survival kit.

Accounts of the country’s fragile public health system in an epidemic failed to blip on the Duterte administration’s radar, with Malacañang’s eyes fixed on the “Build build build” centerpiece program. Just as billions of funds were pumped into infrastructure projects, the health budget was hemorrhaging with big cuts. Money for disease surveillance, for example, was slashed from P263 million in 2019 to P115 million in 2020. The Department of Health budget of P172 billion was below the World Health Organization’s prescribed 5 percent of GDP.

Absent contingency facilities dedicated to epidemics, the Athlete’s Village in Tarlac was used to isolate Filipino expatriates weeks after COVID-19 began threatening the country. Some LGUs have improvised by putting up tents and retooling schools, hotels, and dormitories into quarantine facilities. But the Research Institute for Tropical Medicine was limping in sample analysis, causing a gridlock in virus detection. The apparatus for disease detection and mitigation—including regional labs, referral hospitals, and isolation areas—was unloaded two months after the first COVID-19 case hit the Philippines.

The government’s response to the COVID-19 threat has been slow and reactive, and not proactive. It is symptomatic of the country’s governance in which policies are short-lived, framed by presidential terms, with priorities shifting from one regime to the next. Health care has also been infected by the neoliberal market economy and public-private partnership. With the state absconding on its public health accountability, the sick are left as end-users of pharmaceuticals, insurance firms, and private hospitals.

Yet for decades, the telltale signs of a weak public health system and the people’s vulnerability to epidemics were accessible for policymakers’ scrutiny. The numbers showed GDP growth but with widening income divides, the failure of health devolution, the lack of access to primary health care among the poor, and the brain drain of health professionals. Infectious diseases, many of which were believed to have been eradicated, kept bouncing back along with new ones—TB, polio, flu, pneumonia, HIV/AIDS, swine flu, and dengue. It is high time that public health is lifted out of the ICU and put in the frontline of national priorities. This needs a government that takes public interest to heart. Research and development deserves full support, and policymaking should be science-based. Development cannot thrive solely on “economic fundamentals,” and this should be replaced by human fundamentals like health. The earlier we take this route, the better we will be in saving lives.

Bobby M. Tuazon is CenPEG director for policy studies and teaches at the University of the Philippines Manila.