PART I: RESPONDING TO THE BASIC NEEDS

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. 

Table 1.1 Vital Health Indicators, Bicol Region, 2007-2008

                  Sources: NSCB, DOH-CHD 5

   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.

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