In 2015, the World Health Organization (WHO) recognized a government hospital for being a “role model of the WHO-Western Pacific Regional Office for its essential newborn care programs, which have been proven to reduce infant morbidity and mortality.” Today, June 9, 2016, the Department of Health (DOH) will close the facility supposedly due to the hospital buildings’ lack of structural integrity.
Employees of the hospital, patients and families have been protesting against the impending closure and eventual privatization of the Dr. Jose Fabella Memorial Hospital. The Aquino government has included the hospital in its public private partnership (PPP) plan to be “modernized” and included in a complex of privately-operated hospitals where the primary goal is to profit from health services.
The state of worsening maternal health in the country is an alarming reflection of the country’s poor public health system and neglect of mothers and the newborn. The impending privatization of the Fabella Hospital is only the latest blow against poor mothers from a government that has a bad record of ensuring maternal health.
Poor outcomes due to poor access
Maternal mortality and universal access to reproductive health have deteriorated in the Philippines in the last 15 years. Maternal mortality rate (the percentage of women who die while pregnant or within 42 days of termination of pregnancy) has worsened, for instance, from a decade-low of 162 deaths per 100,000 livebirths in 2006 to 221 deaths per 100,000 livebirths in 2011, according to the Family Health Survey. According to the National Economic and Development Authority, infant mortality was at 22 per 1,000 live births. A children’s rights group reported a huge gap for newborn deaths between the poorest and wealthiest households as of 2014.
In the Philippines, poverty prevents women to access maternal and other health services. Based on the latest National Demographic Survey (NDHS), only four out of 10 of livebirths belonging to the poorest 20% were delivered by a skilled provider such as a doctor, nurse or midwife while all livebirths belonging to the richest 20% were delivered by a skilled provider. The rest of the livebirths belonging to the poorest 20% were delivered by hilots or traditional birth attendants. Only four out of 10 livebirths belonging to the poorest 40% were delivered in a health facility while nine out of 10 livebirths belonging to the richest 20% were delivered in a health facility.
The high cost of availing health services primarily prevents access. For women who were not able to deliver in a health facility, four out of 10 said that they were not able to do so because it costs too much. For overall health services when they are sick, six out of 10 women belonging to the poorest 40% who said that they had problems accessing health care said that it was because they had difficulty in getting money for treatment.
Distance to health facilities, which has a dimension of cost for transportaiton, is the second most common reason for women’s difficulty in accessing health services. Four out of 10 women belonging to the poorest 60% who reported to have problems in accessing health care cited the distance to the health facility as their health problem. Overall, seven out of 10 women belonging to the poorest 60% reported that they had problems in accessing health care compared to only five out of 10 women belonging to the 40% richest who do.
Public to private
Established by Dr. Jose Fabella in 1922, Fabella Hospital is the first midwifery school in the Philippines which has been producing midwives who would become the backbone of the country’s rural public health services.
The only public hospital in the country specializing in maternal and neonatal care services, Fabella Hospital has a unique role in providing these services for the poor. Standing in the Old Bilibid Prison compound in Manila, it has evolved from a six-bed Maternity House in 1920 to a 700-bed capacity hospital that accounts for around 20% of babies delivered in Metro Manila. The hospital’s authorized bed capacity can even as go as high as 120%, with two to four patients occupying one bed on regular days.
It has specific wards for various maternal and neonatal care needs. According to the Alliance of Health Workers (AHW), Fabella serves around 2,000 inpatients and outpatients daily. On a normal day, the following departments serve the following number of patients: outpatient for pediatrics, 150; obstetrics, 200 patients; gynecology, 50-100 patients; in patient pediatrics, 95 patients; NICU, 30-60 babies; and, post abortal, 12 patients. It records 15 total deliveries in caesarian section and 35 normal spontaneous deliveries daily.
However, government attempted several times to close, transfer or transform Fabella Hospital in the past one and a half decades. First, the National Center for Women’s Health contained in the DOH Medium Term National Hospital Development Program 2001-2010 did not push through. Second, the government-owned Home Guaranty Corporation (HGC) sought to develop the property in 2007. The hospital director announced that Fabella’s structure is weak and must be closed but public protests prevented the closure. Still, the national government made no move to repair and retrofit the hospital, nor allocate capital outlay budget for the years 2011, 2013 and 2015.
Once again in September 2015, the HGC itself demanded Fabella Hospital to vacate the premises. In April 2016, new medical center chief Dr. Esmeraldo Ilem announced that the hospital should be vacated because it did not pass accreditation due to lack of structural integrity. While a new hospital is being completed, employees and patients will have to go to other hospitals such as the National Center for Geriatric Health (NCGH), a 50-bed facility for the elderly; the decrepit Tala Leprosarium specializing in leprosy care; and a small non-hospital building within the compound of the Lung Center of the Philippines (LCP).
To date, the government does not have concrete plans on how and where to relocate displaced patients. The NCGH, Leprosarium and LCP are not geared to serve maternal and child care functions. The AHW also said that all positions in these hospitals are already filled, thus increasing the likelihood that Fabella employees will not absorbed or may be terminated. Resident physicians have in fact already been served their termination of contract by 2016.
President Aquino has included Fabella Hospital in the Trimedical Complex Modernization Project, a PPP program which involves the modernization and integration of three medical centers in one compound. According to the plan, the Fabella Hospital (maternity and child care) will be located side by side with Jose Reyes Medical Center (a highly populated hospital specializing in general hospital surgery and internal medicine) and San Lazaro Hospital (infectious disease control hospital) in the DOH compound in Tayuman, Manila. Through the PPP, the private sector will upgrade and integrate the support facilities and ancillary services of the three hospitals into a common facility and operate it. Bed capacity will be increased by building new facilities such as a diagnostic facility, pharmacy, cancer center, medical arts and parking building, training center and research center. Facilities will also be upgraded by adding a morgue, autopsy and crematorium, among others.
On January 2013, in an apparent move to woo investors for the Trimedical PPP, the DOH posted an invitation to bid for the design and the construction of the new Fabella Hospital in the DOH compound, with an allotment of Php750 million. In May 2014, the National Economic Development Authority (NEDA) approved the Php2 billion project which was eventually awarded by the DOH to J.D Legaspi Construction in February 2015. The project involves the construction of a new 9-storey, 800 bed hospital with emergency room facilities and other attendant facilities for a maternal and neonatal hospital by December 2016. In September 2015, the DOH would report that the construction of a new 400-bed facility has commenced and will be completed by 2018. This facility reduces by half Fabella’s current bed capacity.
The Trimedical Complex PPP is among the projects that the incumbent administration will leave unfinished. Incoming finance secretary Carlos Dominguez said that the next administration will accelerate PPPs and implement it on a faster pace. However, the inclusion of health services and facilities under a PPP or other privatization arrangements will only worsen the already alarming state of maternal health. “Modern” services promised by the government under these arrangements stand to be inaccessible to the poor because the public nature of such services is cast aside in favor of profit-making.
With the already alarming state of maternal health in the country, the closure of Fabella Hospital and its impending privatization is like the last nail on the coffin for poor mothers. Privatizing health services only seeks to make health as an arena for profit-making instead of making health services available to those who need it most. Instead of privatizing health, the government should ensure the upliftment of maternal health not only by spending for direct service provision — from preventive to curative services — but more importantly by creating better economic conditions to create jobs and provide decent incomes.–IBON Features