In the last two years of President Duterte, policymaking should pivot to a reform track. Such policy shift should consider enhancing the country’s public health care system and nurturing health professionals—a priority long ignored by politics-ridden lawmaking.
Had politicians listened to a pioneering bill filed seven years ago, the country’s public health and disease mitigation system might be in a better shape today to cope with the COVID-19 pandemic. In 2013, Sen. Miriam D. Santiago’s Senate Bill No. 1573 sought to strengthen national response and preparedness for public health emergencies like pandemics. Santiago wanted an inter-agency Task Force on Public Emergencies formed under a national health strategy. The country was then reeling from the impact of MERS and SARS, aside from dengue and other outbreaks.SB 1573 never took off. Congress was locked for the next few years in the political heat of the pork barrel scam, “Yolanda” aid corruption, the Mamasapano carnage, and other headline-hogging issues.
On closer scrutiny, the bill sets the tone for an urgent national health strategy in light of forecasts that the novel coronavirus will rage no end and that it will bounce back as a seasonal virus threat. This is not the only reason, however, given the country’s poor public health capacity in dealing with other long-drawn communicable diseases and outbreaks with high human and economic costs.
Three modalities can be taken to prop the public health capacity and preparedness: instituting an early warning system (EWS), sustaining health care professionals and workers, and implementing a barangay machinery for mass mobilization.
Aided by satellite imaging, digital technology, and risk mapping, EWS involves disease surveillance powered by systematic data collection to track infections and outbreaks, and area vulnerabilities. This tool helps predict the emergence and spread of infectious diseases, giving health authorities time to be on war footing and armed with locally-produced paraphernalia like personal protective equipment and test kits.
Epidemic surveillance and preparedness, however, will need the country’s 42,000 barangays for data and monitoring while serving as the first line of early detection and mitigation. Primary health care needs strengthening on top of rejuvenating barangay health stations (BHS), which exist in only a third of all barangays. Cuba, Vietnam, and China are models of the kind of collective village mobilization in curbing COVID-19 that’s also apt for Philippine conditions.
A proactive public health system, however, will be inadequate without giving a massive financial dose to the country’s health care workers. Low salaries and state marketing of foreign job opportunities continue to push health professionals out of the country, leaving a huge gap in public health human resources.
These measures will matter only when policies that led to the deterioration of the country’s public health system are scrapped. One of these is the bitter structural adjustment program prescribed decades ago by multilateral lenders reducing health and social spending, as well as privatizing state resources like public hospitals. Education also needs to be retooled, while migration, now a major industry that sends armies of medical workers to treat the sick and elderly of rich countries, should be revisited.
Aptly, Sen. Grace Poe on April 28 filed SB 1450 or the “Pandemic Preparedness and Response Act” that seeks to establish a Center for Disease Control (CDC) for the country. The CDC will strategize and lead in communicable disease control and prevention, and “fortify the country’s preparedness and response to public health crises.” The bill, Poe said, drew inspiration from the efforts of Santiago, who died of cancer three years after filing her bill.
Poe’s bill should go with other measures to stop public hospital commercialization, provide a nurturing environment for public health professionals, and increase hospital capacity. Congress should revise the 1991 local government code in light of its failure to devolve health services, while infusing money for community health infrastructure, including BHS.
Public health has never been an electoral issue. It will soon be, as COVID-19 has become not just a health issue but also a crisis of governance and leadership.
Bobby M. Tuazon is CenPEG policy studies director and teaches at the University of the Philippines Manila.