I.
Summary
The health challenges posed for the period 2008-2010 were
given focus through the implementation of programs to: (1)
minimize health problems and improve health outcomes; (2)
assure access to quality and affordable health facilities
and services especially for the poor; (3) improve
availability of basic and essential health care services;
and (4) improve health system performance at the local
level.
For 2008, these objectives were responded to as shown by
some favorable health outcomes,
improved delivery of health services and supportive
and effective local governance.
Crude death rate decreased from 4.59 deaths per 1,000
population in 2007 to 4.46 deaths in 2008. Infant deaths per
1,000 live births was 8.1 deaths while maternal deaths per
1,000 live births was 0.82 deaths. A decreasing incidence of
mortality from communicable diseases was noted. There was a
decline in the percentage of households with access to safe
water and sanitary toilets. The ratio of hospital to
population was 1:43,839. Generally, health services were
still inaccessible to many Bicolanos. Provinces in the
region were also active stakeholders in the health system.
II.
Assessment
Health
Outcomes
Improving health indicators.
Vital health indicators registered significant improvements.
The average life expectancies for males increased from 67.88
years in 2007 to 68 years in 2008 and for females from 73.29
years to 73.47 years (Table 1.1). Crude death rate decreased
from 4.59 deaths per 1,000 population in 2007 to
4.46 deaths in 2008. The
10 leading causes of mortality among the general population
included pneumonia, trauma injuries, heart diseases,
neoplasm and all forms of tuberculosis. Infant deaths per
1,000 live births was 8.1 deaths, lower than last year’s 9.6
deaths. The leading causes were pneumonia, septicemia,
congenital anomalies, prematurity and diarrhea. Maternal
deaths decreased from 0.90 deaths per 1,000 live births in
2007 to 0.82 deaths in 2008. Leading causes were
complications related to pregnancy which occurred in the
course of labor, delivery and post-delivery, hypertensive
disorders, childbirth and abortive outcomes. The coverage of
facility-based deliveries was 24.28 percent which was way
below the target of 60 percent. Maternal health care
services should therefore be prioritized since all causes of
deaths are preventable and easily addressed with the full
implementation and support of the maternal, newborn, child
health and nutrition programs.
The health challenges posed for the period 2008-2010 were
given focus through the implementation of programs to: (1)
minimize health problems and improve health outcomes; (2)
assure access to quality and affordable health facilities
and services especially for the poor; (3) improve
availability of basic and essential health care services;
and (4) improve health system performance at the local
level.
For 2008, these objectives were responded to as shown by
some favorable health outcomes,
improved delivery of health services and supportive
and effective local governance.
Crude death rate decreased from 4.59 deaths per 1,000
population in 2007 to 4.46 deaths in 2008. Infant deaths per
1,000 live births was 8.1 deaths while maternal deaths per
1,000 live births was 0.82 deaths. A decreasing incidence of
mortality from communicable diseases was noted. There was a
decline in the percentage of households with access to safe
water and sanitary toilets. The ratio of hospital to
population was 1:43,839. Generally, health services were
still inaccessible to many Bicolanos. Provinces in the
region were also active stakeholders in the health system.
Morbidity and mortality rates from cardio-vascular diseases
was still on the rise due to unhealthy lifestyles such as
smoking, alcohol intake, lack of physical activity, high
cholesterol diet and the rising existence of diabetes and
hypertension. Meanwhile, the technology for the control of
both communicable and non-communicable diseases was in
place. However, problems on implementation could be traced
on health care delivery, level of awareness, motivation and
participation of the population in health-related concerns.
Improved system of disease surveillance.
Disease surveillance in 10 identified sentinel sites in the
region revealed a decrease in cases of diseases. A total
of 2,607 cases were monitored showing a 30 percent decrease
compared to 3,739 infectious cases seen in 2007. Among those
which had decreased incidence were malaria (80%), cholera
(65%), dengue (48%), Hepa B (100%), Hepa A (18%), neo-natal
tetanus (16%) and rabies (4.9%). Diseases which increased
were measles (273%), leptopirosis (184%), bacterial
meningitis (100%), neonatal tetanus (100%), typhoid fever
(46%), and acute flaccid paralysis (41%). The incidence of
these diseases was greatly influenced by changes in the
weather particularly during the prolonged rainy season in
the region.
Despite the increase in immunization coverage for children
for immunizable diseases from 78 percent in 2007 to 82.59
percent in 2008, increases were still noted in the incidence
of measles and neo-natal tetanus. For measles, the increase
was attributed to discrepancies in reported immunization
coverage in some areas. In the case of neo-natal tetanus,
the low immunization coverage of pregnant women and the
preference of mothers to seek untrained hilot during
delivery were seen as causative factors.
Part of the surveillance activities were the conduct of
studies on malaria in Camarines Norte, malacologogical and
schistosomiasis case finding in Sorsogon, and survey on
tobacco, health promotion activities, and post disaster
disease surveillance regionwide.
Declining access to water supply and sanitation.
The percentage of households with access to safe water
declined from 83.8 percent in 2007 to 79.95 percent in 2008
(Table 1.1). Access to sanitary toilets also decreased
from 66.3 percent to 64.33 percent. Even with such trend the
incidence of diarrhea cases reduced from 21,965 in 2007 to
12, 232 cases in 2008.
Availability of Quality and Affordable Health Facilities and
Services
Facilities. Health facilities in the region
were operated by the government, private sector and non-
government organizations. The region had 116 hospitals, 50
government and 6 private, yielding a ratio of 1 hospital to
43, 839 population. Meanwhile, there were 125 rural health
units (RHUs) and 1,090 barangay health stations (BHS) in the
region. Other facilities included birthing homes, dialysis
clinics, psychiatric care facility and ambulatory surgical
clinic. These were mostly concentrated in urban centers.
These facilities were covered by the regulatory functions of
the Department of Health.
Government and private hospitals have been upgrading their
facilities and equipment prompted by the shifting trends in
the incidence of diseases that need modern diagnostic and
therapeutic technology. This, however, resulted in the
escalation of the cost of health care which further
compromised the access of marginalized sectors to
specialized health care. On the part of the government,
hospital services expanded to include promotive and
preventive services. Hospitals are now being promoted as
Centers of Wellness where the promotion and maintenance of
health is provided through humanized care.
Health programs and services.
The local government units made efforts in the delivery of
health programs and services to their constituents. For
maternal care services, the proportion of pregnant women who
go to health facilities for at least 3 times was 63.76
percent while those with 4 or more visits was 56.69 percent.
The expanded program on immunization for infants and
children achieved 78 percent fully immunized children (FIC)
coverage but was still below the 95 percent standard rate.
Tetanus toxoid plus (TT2+) immunization served 57.80 percent
of the pregnant women.
For filariasis control, coverage for mass treatment was
71.29 percent. This was way below the 85 percent target. The
333 malaria confirmed cases were all given treatment.
Leprosy-diagnosed cases yielded 47. Continuing treatment was
administered to 54 patients and completed treatment to 51
patients.
Among the factors identified that denied access to health
services in the region were: (1) lack of information on
available health care services; (2) lack of accessible and
affordable transport facilities that would allow better
access to health care facilities; (3) unavailability of
public health facilities in remote areas; (5) persistence of
socio-cultural values and belief systems preventing
acceptance of appropriate and effective health services; and
(6) high cost of health care especially those requiring
hospitalization, expensive medicines and diagnostic
examinations. Some of these problems, however, were
responded to in 2008 with the enhancement of initiatives for
better access to health such as the health insurance
program.
The National Health Insurance Program is an effective tool
in speeding up the delivery of health care services and fast
tracks the achievement of the objectives of FourMula One and
the Millennium Development Goals. For 2008, membership for
health insurance coverage expanded from 490,512 in 2007 to
633,863 in 2008 showing a growth rate of 29.22 percent. This
translated to a coverage ratio of 59 percent of the 2008
population but was still below the targeted 65 percent.
Majority (39%) were sponsored members, followed by the
private sector (22%), government (17%), individually paying
members (12%), overseas workers (7) and non-paying (3%).
Despite the socio-economic setbacks resulting from the
effects of the typhoons in late 2006, there was a steady
rise in the membership coverage among the employed sector,
the individually-paying members (IPMs) and the overseas
workers. There was also a rise in the enrolment of the
informal sector comprising 61.3 percent of the membership
base. This was due to the increase in coverage of enrolment
from Albay and the roll-out of the Kalusugang Sigurado at
Abot Kaya sa Philhealth (KASAPI) program where organized
groups provided more flexible payment schemes for affordable
social health insurance.
In terms of services, PhilHealth paid P607.3 million for the
claims of its beneficiaries, up by P16 million over 2007’s
P591.3 million. Utilization was highest for the overseas
workers outpatient benefit package benefiting the Overseas
Workers Program members and their legal dependents. The
package included services such as consultations, diagnostic
laboratory tests, preventive and promotive health and
curative services.
Accredited facilities in the region totaled 199 consisting
of 89 hospitals, 78 RHUs, 2 free standing dialysis clinics,
5 maternity care clinics, 23 TB-DOTS and 2 ambulatory
surgical clinics. Meanwhile, the number of accredited
professionals more than doubled at 556 compared to last
year’s 204.
Performance at the Local Level
The provinces in the region were active stakeholders in the
health system. Inter-Local Health Zones (ILHZs) were
established for collaborative undertaking and sharing of
resources for health considerations. As of 2008, organized
ILHZs totaled 21: Albay-3; Camarines Norte-2; Camarines
Sur-4; Catanduanes -4; Sorsogon -4; and Masbate – 4.
Partnerships in various health programs existed, i.e. TB
control, chronic disease prevention and control, disease
surveillance system, health emergency disaster preparedness
and response and health facility development. All
established ILHZs were covered with local ordinances.
III.
Prospects and Trends for 2009
Despite the gains in the general improvement of health
indicators, there are still issues affecting the achievement
of planned goals and objectives. These include the need for
a more efficient and effective delivery of basic health
services through the provision of adequate funding for the
basic health services.
For the rest of the planning period, priority shall still be
the provision of adequate and essential health services to
all focusing to the vulnerable and marginalized groups.
Primary health care will still be the key approach of the
health care delivery system. Emphasis shall be given to
promotive and preventive health care which will be
integrated in the service delivery of primary health care
programs and in the curative care facilities such as clinics
and hospitals. Priority programs shall be advocated and
promoted for LGUs and other stakeholders to include
strengthening and sustaining mother-baby friendly
initiatives in hospitals, newborn screening informed choice
and responsible parenting, rabies-free initiatives, among
others. Regulatory activities for health facilities,
establishments and health professionals shall include
monitoring of low-priced drugs, medicines and health
facilities.
For social insurance, initiatives shall be geared towards
sustaining and increasing the membership coverage of at
least 65 percent for the region, increasing financial
protection for NHIP members in terms of roll-out of new
benefit packages, implementation of progressive contribution
payment and new provider payment mechanism, and enforcing
efficient resource management.
