‘No regrets’

During the recent CNN presidential forum, presidential candidates were asked whom they would appoint as the next health secretary under their administrations. Vice President Leni Robredo responded that the next health secretary ought to be an expert in the field, should be respected by peers, should be hands-on, and should be able to command leadership. Ernesto Abella stressed the importance of integrity, intelligence, and energy, as well as the need for a medical background and managerial excellence. He also added the importance of an appropriate vetting process to find candidates to fit such a role, since the “best and the brightest” would not necessarily come from “friends and appointees.” One wonders how the performance of the incumbent secretary of health compares to these descriptions. This is in light of Health Secretary Francisco Duque freely and favorably commenting on his performance as this administration comes to an end.

There’s no doubt that Duque is a doctor who fulfills the need for a medical background, which is to his credit. There is a longstanding debate, however, as to whether only physicians should be appointed as health secretaries: they do not hold a monopoly on the relevant expertise, and a medical hegemony may be more harmful than helpful. The reader may find helpful some references such as the British Medical Journal’s 2001 article “Public health does not need to be led by doctors.” Regardless, what the pandemic has clearly shown us is that the next secretary of health must be able to work with those in other disciplines and recognize their expertise. This has not always been the case with the current health secretary. The face shield debate alone is evidence enough that due recognition must be given to expertise in other fields that will also impact health outcomes.

Our presidential aspirants also seek a leader respected by their peers. It is no exaggeration to say that Duque has not only been the subject of much criticism from his peers in health work but from his peers in politics as well. Multiple protests were staged calling for his resignation last year. Doctors have publicly stepped up to criticize Duque’s leadership. After Director-General Eric Domingo resigned from his post in the Food and Drug Administration, former vice president Jejomar Binay said Duque should have resigned instead, “for his mismanagement of the medical response to the pandemic.” He also said, “If we want the economy to recover, the solution is to improve our medical response to the pandemic. That will never happen under Duque’s watch.” In an interview, former health secretary Esperanza Cabral said that if she were in his place, she would have resigned a long time ago. There appears to be a general feeling that Duque’s leadership is certainly guilty of incompetence, and probably guilty of corruption.

Abella stressed the need for integrity. One remembers that the Senate blue ribbon committee has recommended charges against Duque and Pharmally officials for allegedly plundering public funds meant for the COVID-19 response. Duque surprisingly said last week that he has “no regrets” over the government’s deals with Pharmally despite these allegations of corruption. “No regrets,” he said, “marami naman tayong na-save na buhay ng health care workers natin.” It underplays how much health workers had to rely on the private sector to fill in the gaps for protective equipment, and how much the supposedly plundered funds could have helped more Filipinos. It is also unpleasantly evocative of something we regularly hear about corrupt politicians: “Okay lang kung nagnakaw, may nagawa naman.” (It’s okay for an official to be a thief if they’re still able to spare us something.) Does an attitude that so normalizes corruption have a place in future public health leadership?

It may be too much to hope for, but I also hope that we may never again see health leadership so strongly controlled by the president. Despite public outcry, Duque was kept firmly in presidential favor with such statements as “I will stand for Duque even if will bring me down.” The President repeatedly dismissed calls for Duque’s resignation. Would such relationships be prevented by a better vetting process? Presidential aspirant Abella seems to hope so. One also hopes that the future president may have a better response to legitimate criticism.

While there may be no perfect leaders in a time of a global health crisis, it is clear that the pandemic has taught us a few lessons on what a secretary of health should and should not be. Duque may have no regrets, but apparently, many health workers and average Filipinos do.

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