CHAPTER 4  HEALTH

Introduction

 

   Health is a basic human right and is an influential factor in attaining an ideal level of development. A healthy population brings out a socially and economically productive population with longer life expectancy, low infant and maternal mortality, less disability, with adequate shelter, education and means of livelihood. Thus, investing in health by the government and other sectors has to be pursued to deliver an effective and efficient health care system in the region.

 

Development Challenges

 

   In 2004-2006, the health sector had both gains and pitfalls. The gains include better health outcomes such as longer life expectancies for both males and females, reduction in live births, maternal deaths, and Total Fertility Rate, and decrease in the prevalence of malnourished preschoolers. There were also modest achievements in the implementation of public health programs. These are attributed to a more improved and focused health care delivery system. However, these still need to be sustained and be made consistent with the community’s political and cultural traditions.

 

   The pitfalls include: (a) increase in the number of cases of morbidity and mortality including infants; (b) reduction in the number of households and families who had access to both potable water and sanitary facilities; (c) decrease in the number of individuals and families covered by health insurance benefit packages; and (d) reduction in the number of clientele provided with micronutrient supplements for improved nutrition of the vulnerable groups and antigens for immunizable diseases in infants and pregnant mothers. These outcomes are attributed to inadequate health service packages, poor health-seeking behavior of the public, inability to afford costs of health services, inaccessibility and/or non-availability of the essential health goods and services and lack of logistic support for medicines, food supplements and medical supplies, and monetary counterpart of sponsoring LGUs and other entities for PhilHealth benefits.

 

Vital Indicators

 

   The 2000 population census estimates life expectancy at birth for both male and female have improved. Male life expectancy for the period 2005-2010 is 66.11 years, an increase over the 64.11 years posted for the period 2000-2005. The female population still outlive the males with their life expectancy estimated to be 71.09 years for 2005-2010, also indicating an increase from 69.09 years in 2000-2005. Crude birth rate (CBR) was reduced from 29.1 births per 1,000 population in 2004 to 28.1 births per 1,000 population in 2006.

 

   Crude Death Rate (CDR) of 4.84 deaths per 1,000 population in 2006 increased by 0.54 percentage points from 4.3 deaths per 1,000 population in 2006. Infant Mortality Rate (IMR) also increased from 9.33 infant deaths per 1.000 livebirths to 10.59 deaths. The leading causes were respiratory diseases, septicemia, prematurity, congenital anomalies and diarrhea. Aside from deaths, there was also an increase on morbidity cases caused by acute respiratory infections, bronchitis, diarrhea, hypertension, pneumonia, bronchial asthma and congenital anomalies. At the end of 2006, epidemics reported include food and waterborne diseases such as cholera, diarrhea, hepatitis A and typhoid fever. Other epidemics reported were leptospirosis, tetanus, meningococcemia, food poisoning and rabies.

 

   Maternal Mortality Rate (MMR) slightly increased from 1.16 deaths in 2004 to 1.19 deaths per 1,000 livebirths in 2006 with the following leading causes --- hemorrhages related to pregnancy, eclampsia, puerperal infection and ectopic pregnancy. This maybe attributed to inadequate knowledge and fertility management, poor nutrition practices and poor access and delivery of maternal care services.

 

   Of particular significance is the result of the 2005 Family Planning Survey (FPS) which reveals that 45 percent of all deliveries were attended to by health professionals. The majority (54.1 percent) are still attended by hilots, friends and relatives, particularly those residing in rural areas where hilots are more accessible, less expensive, and tend to share in taking care of the family. Expansion of coverage of the maternal care service delivery –pre-natal, natal and post-natal services, training of midwives and barangay health workers on maternal care and education is therefore warranted by maximizing the capabilities of birth attendants and health educators in information dissemination on childbirth care.

 

   The percentage of households with potable water slightly decreased from 82.7 percent in 2004 to 82 percent in 2006. This is probably due to changes in the non- potability of water as a result of contamination of water sources. Households with sanitation facilities decreased from 67.85 percent in 2004 to 64 percent in 2006. This is attributed to the lack of support for the construction of toilets in the local government units.

 

 Health Care Financing

 

   The National Health Insurance Program (NHIP) aims to provide health insurance coverage and ensure affordable, acceptable, available and accessible health care services for the whole population. For the plan period, the program targeted to conduct information dissemination campaigns, encourage local chief executives to support the Indigency Program and accredit more health facilities.

 

   In 2004-2006, it has expanded insurance coverage across sectors, except for the indigents. More health packages were available, such as tuberculosis directly observed treatment short course (TB-DOTS), malaria and maternity packages. The number of government employees covered by the program increased from 92.001 in 2004 to 102,443 in 2006. Private employee coverage also increased from 73.470 in 2004 to 114.199 in 2006 while individually paying members reached 86,198 in 2006 from 50,126 in 2004. The increase in the number of beneficiaries for the employed, individually-paying and overseas workers is attributed to the aggressive information dissemination campaign of the PhilHealth staff to encourage the individually-paying members for continued membership. Media activities were done through monthly spots in radio stations for updates on the health program.

 

   The number of indigent household members decreased from 566,375 in 2004 to 344,622 in 2006. This is due to the discontinued subsidies coming from private individuals and LGUs whose support to the program declined from 120 in 2004 to 84 in 2006. To expand coverage for the indigent families, there is a need for advocacy and information of the LGUs to support the program.

 

   The number of accredited facilities increased from 155 in 2004 to 84 in 2006 due to the inclusion of one freestanding dialysis clinic, five maternity care clinics and five TB-DOTS facilities. Accredited professionals also increased from 544 in 2004 to 613 in 2006.

 

Health Regulation

 

   Licensing of Botika sa Barangay (BnBs) was a priority activity to improve access to affordable drugs and medicines. By the end of 2006, 427 BnBs were licensed. Generic prescribing was given emphasis. Monitoring results revealed that correct prescriptions increased from 90 percent to 96 percent. Warning letters to violators followed.

 

   The proliferation of counterfeit drugs in the region was also addressed. Violative products were confiscated and condemned and information dissemination on unlicensed drug distributors was also undertaken. Given these developments, the consumers should become more vigilant in reporting offices, persons or entities involved in illegal sale of drugs to the Department of Health-Center for Health Development (DOH-CHD) or the nearest DOH-Provincial Health Team (PHT).

 

Health Service Delivery

 

   Increased access to health care services were strongly advocated to local government implementers. Such services include preventive and promotive care utilizing the primary health care approach. Despite funding and logistical constraints, public health programs were implemented at the local level. These programs focused on four priorities, namely: (a) safe motherhood and family planning; (b) child and maternal health care; (c) communicable disease control program; and (d) non-communicable disease control program.

 

   On Child and Maternal Health Care. The immunization program coverage of children and pregnant mothers decreased. Fully immunized children covered remained at 82 percent. This is below the target of 95 percent coverage. Causes for the decreased coverage were lack of  syringes for the vaccines, decrease of outreach activities for follow-up of defaulters, rapid turnover of trained health workers, deterioration of the cold chain system, poor stocks management and inadequate of monitoring and supervision. Although the Reach Every Barangay (REB) strategy which validate data and mentor health workers has been implemented, it is still inadequate to cover all barangays with high un-immunized children.

 

   On Communicable Disease Conrol Program. Relative to TB Control, the TB detection rate improved from 79 percent in 2004 to 99 percent in 2006 due largely to treatment administered by trained health personnel. This is due to intensified quality assurance (QA) in four provincial QA laboratories an establishment of three public and one Private Mix DOTS facilities. At the regional level, the Regional TB Reference Laboratory has also started its operations. TB cure rate was 84.3 percent in 2005.

 

   For dengue prevention and control, there was intensified campaign on source reduction and environmental sanitation (Operation Kiti-Kiti and the 4 o’clock Habit). Provision of logistics and training for early case detection was also implemented.

 

   In the case of Malaria Control Program, Masbate and Sorsogon have been declared as malaria free by the World Health Organization (WHO). Albay is in the process of being declared as malaria-free. There is still continued diagnostic and management capability trainings being undertaken particularly on malaria surveillance and vector control (MASSUVECO), basic malariology and malaria smear microscopy.

 

   On filariasis control, efforts were focused on morbidity control and mass drug treatment (MDT). For 2006, MDT accomplishment was 63 percent.

 

   Early diagnosis and treatment was given emphasis for leprosy control while the Schistosomiasis Control Program focused on malacological surveys in preparation for it being being eliminated as a public health problem.

 

   On Non-Communicable Disease Conrol Program. Under the Rabies Control Program, the curriculum integration project was expanded to 8 elementary schools in Cabusao, Camarines Sur. There was also pre-exposure anti-rabies vaccination given to schoolchildren. Intensified dog vaccination dubbed as “askal” elimination was also conducted in the region.

 

   For epidemiology and surveillance, surveillance activities were undertaken for cases of cholera, diarrhea, typhoid fever and dengue. In response to epidemic occurrences, and other health-related emergencies,  disaster Response Teams were organized.

 

   Expansion of the Healthy Lifestyle Program focused not only on target risk factors and risky behavior (smoking, road safety, dangerous drug use, etc) but covered other aspects such as limiting the ill-effects of environmental risks and hazards such as garbage, flooding, pollution (air and water), emergency management, traditional medicine and voluntary blood donation. There is also increased emphasis on diabetes, renal diseases, cancer, heart disease and other degenerative diseases.

 

Health Systems Development

 

   For effective and efficient health care delivery, inter-local health zones were strengthened, municipalities/cities were assisted to facilitate Sentrong Sigla certifications and additional Botika sa Barangay were established and provided with drugs and medicines.

 

   Despite the improvements in the health sector, problems still persist. Preventable communicable diseases like diarrhea, pneumonia and bronchitis still remain as the leading cause of illnesses. The prevalence of tuberculosis and lifestyle diseases such as diseases of the heart and the vascular system prevail as the leading causes of death. With these trends, hospitals are expected to acquire modern and diagnostic and therapeutic technology for secondary and tertiary care. Access to health care and health-seeking behavior remain poor due to geographical inaccessibility of facilities, low income of families, high cost of medicines and hospital care and lack of knowledge on proper health care. Health facilities  still lack physical and human resources. There is still lack of LGU support for program implementation particularly those related to health service delivery.

 

Development Objectives and Targets

 

   The objectives and the corresponding targets for each objective are:

1. To minimize health problems and improve health outcomes by year 2010.

1. Decrease in IMR. MMR, CMR from 2005 levels by 5-10 percent in 2010.

2. Decelerate incidence of communicable diseases by an increment of 1-2 percent per year until 2010.

3. Decrease in mortality cases for lifestyle-related diseases by an increment of 3-5 percent per year until 2010.

4. Increase in the number of health facilities equipped with modern diagnostic and therapeutic technology by 50 percent in 2010.

5. Reduce the prevalence of water-borne diseases by at least 10 percent per year until 2010.

2.  To assure access to quality and affordable health products, devices, facilities and services, especially those commonly used by the poor.

1.  Increase access to health services with improvements in bed-population ratio, manpower-population ratio.

2. Reduce of cost of medicines commonly bought by the poor to half of its 2005 price and made available in all DOH-retained and district hospitals.

3. To improve the accessibility and availability of basic and essential health care for all, particularly the poor.

1.  Increase the number of households with access to potable water and sanitation facilities by 80 percent and 86 percent, respectively, until 2010.

2. Increase enrolment of individually-paying and indigent/ sponsored members to the NHIP by about 5 percent annually until 2010.

3. Increase health insurance coverage of PhilHealth members and their beneficiaries by 5 percent annually until 2010.

 4. To improve health systems performance at the local levels.

a. Establish seven inter-local health zones (ILHZs) by 2010.

Strategies

 

   The strategies that will promote improvement in the nutritional status of Bicolanos are:

1. Promote the health well-being of the vulnerable groups, i.e., infants and children, young and adolescents, women, people with disabilities and the elderly.

2. Put emphasis on preventive and promotive health services in health care facilities.

3. Promote integrated programs for the prevention and control of communicable and non-communicable diseases and other emerging illnesses.

4. Assure the availability of low-priced quality essential medicines commonly used by the poor.

5. Intensify advocacy efforts to expand the NHIP among the LGUs and employers and develop innovative strategies, i.e. LGU voucher system for health services.

6. Develop collaborative schemes involving private health insurance and health maintenance organizations.

7. Enhance capability of local government units to manage and administer devolved health functions.

8. Develop modern health and rehabilitation facilities --- hospitals, clinics, city/municipal health centers and barangay health stations, laboratories and other entities --- where health and rehabilitation services are provided.

Major Programs and Projects

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