Health Privatization

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Prior to #WorldConsumerRightsDay, Filipino consumers including those for a #BetterDigitalWorld converged in a forum, expressed their woes and aspirations and vowed to continue working for #SocialEconomicChange

Various consumer groups gathered in a conference last Monday in Quezon City to tackle the social and economic reforms needed to promote consumer welfare. The event participants recognized the need to pursue real social and economic reforms in order to resolve current consumer issues and uphold consumer rights.

The forum dubbed “CASER: What Is In It For Consumers? A Conference on the Comprehensive Agreement on Social and Economic Reforms and Consumer Welfare” was attended by representatives from Alerta Mamimili (Gabriela), Bantay Bigas (Rice Monitor), Green Action PH, organic advocates group CHIMES, Kalipunan ng Damayang Mahihirap (KADAMAY), National Consumer Affairs Council (NCAC), People Opposed to Warrantless Electricity Rates (POWER), transport group PISTON, digital rights watchdog Text Power, and Water for the People Network (WPN). The event  was organized by IBON in partnership with Pilgrims for Peace and Kapayapaan Campaign for a Just and Lasting Peace.

IBON research head Rosario Bella Guzman kicked off the conference with a discussion of the adverse impact of neoliberal globalization policies that have led to worsening social inequalities, widespread poverty and hunger and thus increasing consumers’ woes.  This was followed by consumer testimonies from the above consumer groups. Raymond Palatino, Pilgrims for Peace convenor and former member of the Philippine House of Representatives then discussed the significance of the Comprehensive Agreement on Social and Economic Reforms (CASER) in promoting and ensuring consumer rights and welfare.

The event culminated in the conference participants’ affirmation that continued peace negotiations between the National Democratic Front of the Philippines (NDFP) and the Government of the Republic of the Philippines (GRP) can lead to genuine and people-centered development.   In this light, the conference echoed the following calls:

–          People-centered reforms to replace the neoliberal economic policies that the Duterte administration continues to pursue;

–          The assertion and promotion of people’s right to effective participation at all levels of social, political and economic decision-making towards nation building;

–          Participation in activities towards advancing consumer rights and welfare such as public forums, media briefings, legislation and lobbying, mobilizations, and research and education campaigns, among others; and

–          urging government to resume peace negotiations with the NDFP.

The participants concluded the conference with the commitment to work together under a unified national network of consumers that will promote people-centered development as the basis of protecting and advancing consumer rights. ###

FreeDayCareCASER

Pres. Rodrigo Duterte recalled the government’s peace negotiators from negotiations with the National Democratic Front of the Philippines (NDFP) until being given “compelling reason” to resume talks. Research group IBON, however, points out that the most compelling reason for having peace talks are the economic and political reforms on the agenda that can address the roots of armed conflict. Ending the peace talks with the NDFP also ends talks on important social and economic reforms which makes the prospects for their implementation and achieving benefits for the people dimmer.

IBON noted that ceasefires are at most only momentary respites from fighting. The government and the NDFP reaching agreements on genuine reforms, on the other hand, are among the clearest steps towards peace based on social justice. The government and NDFP each prepared their proposed draft for a comprehensive agreement on social and economic reforms (CASER) and exchanged these in mid-January 2017. IBON reviewed these and compared their respective proposals for key reforms.

FreeEducCASER

Pres. Rodrigo Duterte recalled the government’s peace negotiators from negotiations with the National Democratic Front of the Philippines (NDFP) until being given “compelling reason” to resume talks. Research group IBON, however, points out that the most compelling reason for having peace talks are the economic and political reforms on the agenda that can address the roots of armed conflict. Ending the peace talks with the NDFP also ends talks on important social and economic reforms which makes the prospects for their implementation and achieving benefits for the people dimmer.

IBON noted that ceasefires are at most only momentary respites from fighting. The government and the NDFP reaching agreements on genuine reforms, on the other hand, are among the clearest steps towards peace based on social justice. The government and NDFP each prepared their proposed draft for a comprehensive agreement on social and economic reforms (CASER) and exchanged these in mid-January 2017. IBON reviewed these and compared their respective proposals for key reforms.

Photo from International Institute for Environment and Development

While the unorthodox Pres. Rodrigo Duterte gained popular support due to its pro-poor pronouncements and promise of change, research group IBON said that the neoliberal economic agenda prevails as  Duterte’s economic managers and other dominant groups push big business-biased/free market-oriented policies over people-centered reforms.

Nevertheless, IBON also said that the ongoing peace negotiations between the Philippine government and the National Democratic Front of the Philippines (NDFP), of which social and economic reforms and political and constitutional reforms are the next substantive agenda, remain an opportunity to push steps that can benefit the Filipino majority.

IBON conducted its 2016 yearend analysis of economic and political trends during the Duterte administration’s first six months In its briefing paper, the group noted the following as among the glaring socioeconomic challenges that persist:

  • Contracting agriculture.The fastest growing sectors wereconstruction and real estate followed by trade and manufacturing,but agriculture contracted.  The share of agriculture in the economy has shrunk to 8.5%. The production sectors consisting of agriculture, manufacturing, construction and mining slightly declined to 38.5%, the smallest recorded shares in the country’s history.
  • Worsening inequality.The net worth of the 40 richest Filipinos grew by almost 14% between 2015 and 2016 and the profits of Philippine Stock Exchange (PSE) by over 18%; real minimum wage in the National Capital Region (NCR), a proxy for workers’ wages, fell by almost 3% in the same period.
  • Deteriorating jobs. Two out of three employed (63%) or 24.4 million Filipinos are non-regular, agency- hired, informal sector, or unpaid family workers, meaning low-paying and insecure work with poor or no benefits. One of three (34.5%) rank and file workers are non-regular workers. Initial IBON re-estimates of labor force survey figures are over four million unemployed Filipinos and an unemployment rate of over 9%. Underemployed number 7.5 million with an 18.3% rate in 2016. Taken together there are 11.5 million who are without work or are still seeking more work
  • Widening wage gap.  Daily NCR minimum wage remains at Php481. According to IBON estimates, this is barely half of the family living wage (Php1,119 as of 2016) or the amount needed by a family of six for their basic needs. The wage gap again widened from 55% (2015) to 57% (2016).
  • Prevalent poverty. Government reported a lower population poverty incidence of 21.6%, counting 21.9 million poor Filipinos for 2015, or 1.8 million less compared to 2012 figures. However, this employs a very low poverty threshold of just Php60 per person per day based on a conservative food threshold and an outdated estimation of non-food expenses, thus reflecting the situation only of Filipinos in extreme poverty. IBON estimates some 66 million poor Filipinos struggling to survive on around or even less than Php125 per day. IBON’s latest national opinion survey meanwhile showed seven of 10 Filipinos rating themselves ‘poor’.
  • Elusive right to education. . The additional Php8.3 billion allocated is short of being able to give free tuition to all 1.7 million students enrolled at all levels in State Universities and Colleges (SUCs), and does not cover other considerable expenses for registration and other pertinent fees. IBON estimates that an additional Php4.4 billion is needed to provide free tuition for all SUC students. The group also said that since the added budget depended on the discretion of lawmakers and the availability of funds, it may not last beyond 2017. The Commission on Higher Education (CHED) has even announced that not all SUC students will be covered.
  • Shallow ‘universal’ health coverage.  While an additional Php3 billion was reportedly allocated to the Phililppine Health Insurance Corporation (PhilHealth) to ensure coverage for all Filipinos, the support value of PhilHealth remains at 50% while the balance of 50% is still paid out of pocket. Also, the poor and sick remain burdened with hospital expenses as 40% of the number of claims paid to indigent/ sponsored program beneficiaries still needed co-payments. Moreover, the  no balance billing policy for indigents is only applicable to increasingly underfunded government hospitals.
  •  People-centered reforms opposed. While additional support for national irrigation has been approved, the Duterte government’s economic directors are opposed to a moratorium on land use conversions, which further institutionalize land grabbing to the detriment of farmers. The economic managers have also been opposed to granting the Php2,000 pension to the elderly, arguing, among others, that it is anti-poor. Earlier, the Duterte administration clarified that by ending contractualization it meant prohibiting the practice of terminating workers before they assume regular status, thereby still allowing all other forms of contractualization where workers are denied the benefits naturally accorded to regulars.
  • Rich relieved, poor burdened further with tax reform package. The administration plans to fund its infrastructure expansion through a consistently regressive tax plan, which will relieve the richest and big corporations. But the poor will be further burdened through additional taxes on a wider range of goods such as fuel products, and  increased value-added tax (VAT).
  •  Unaddressed roots of “war on drugs”. While there have been 2,166 deaths of ‘drug personalities’ during police operations aside from at least 4,049 more victims of drug-relatedextrajdicial or vigilante-style killings, the socioeconomic roots of the drug problem remain largely unaddressed.

According to the group, the new government may appear different from its predecessors but there are very few indications that substantial change is underway. Under the same profit-driven, market-oriented economic policy framework, the country’s resources remain concentrated in the hands of the wealthiest families and corporations. Despite the President’s strong pronouncements, an independent foreign policy has not been forged; the country has not broken free from foreign powers with geopolitical interests in the Philippines whether it be, for instance, the US or China. Traditional politics prevail. Relatedly, the administration repeatedly dangles authoritarian measures, putting at risk assertions of democracy that are gaining ground.

Nevertheless, IBON said that while prospects for change are getting dimmer rather than brighter, it remains to be seen how the peace negotiations could still possibly effect initial people-centered reforms. It is an opportune time to challenge the administration to, beyond paper, step out of its neoliberal economic and undemocratic political tradition in the direction of crafting policies in the interest of the majority of poor and marginalized Filipinos, said the group.

 

 

From abroadero.com

 

Research group IBON said that Filipinos will benefit if the government adopts Cuba’s model of a state-run health care system. The group stressed that people’s access to this social service is becoming more limited by Philippine health services being increasingly run by the private sector for profit.

Department of Health (DOH) officials recently toured Cuba, known for its excellent health care system, upon the recommendation of Pres. Rodrigo Duterte. Cuba’s revolutionary health system prioritizes community-based preventive health care while offering a free public health service with among the highest doctor-patient and nurse-patient ratios in the world. This gives it among the lowest infant mortality rates and highest life expectancy rates in the world.

IBON welcomes DOH Secretary Paulyn Ubial’s anchoring her department’s All for Health, Health for All theme on learning lessons from Cuba. But the group said that this necessarily means reversing the government’s neoliberal policy of privatizing health services and turning health into a commodity provided by the market to profit from.

The government’s banner program for “universal health coverage” is the health insurance program PhilHealth which reportedly now benefits 97 million Filipinos. But despite PhilHealth taking up the bulk of the national government’s health budget, 68% of Filipino’s personal health care spending is still paid for out-of-pocket.

Recent IBON surveys found that PhilHealth paid less than half of patients’ health expenses and that 7 of 10 PhilHealth sponsored patients in 2014 were still obliged to buy medical paraphernalia outside the hospital during confinement. Poor patients also lamented public hospitals’ lack of medicines, medical supplies, beds and beddings, dirtiness of toilets and lack of cleanliness.

Health services will become more inaccessible to the poor as more than 70 hospitals nationwide face privatization, IBON noted. The average cost of confinement in a private facility is already Php25,741 which is equivalent to 68 working days considering the average daily basic pay in the country of Php380. Even the average cost in a public health facility of Php8,640 is too expensive and equivalent to almost 23 working days.

The Cuban government guarantees access to quality health care for its entire population. The Philippine government can achieve the same, said IBON, by following Cuba’s example of resisting privatization and establishing an integrated national health system that is exclusively and proudly public, the group said.

From archives.pia.gov.ph

The basic economic issues confronting the new Duterte administration will take center stage in the peace negotiations as the next substantive agenda on the Comprehensive Agreement for Soci​al and Economic Reforms. IBON joins the public in aspiring for the soonest resumption of the peace negotiations between the government and the National Democratic Front and the Moro Islamic Liberation Front.

#SONA2016 #justpeacePH | The new administration can ensure unhampered and sufficient social services for all Filipinos, research group IBON said barely a week before the first State of the Nation Address (SONA) of Pres. Rodrigo R. Duterte. It can begin by acknowledging foremost that neoliberal policies, specifically privatization and deregulation, have commodified social services, and must be reversed, the group said.

Education, health and housing are basic rights that have been denied many Filipinos as these have become more unaffordable and inaccessible due to their largely privatized or corporatized state and direction, said IBON.

Youth groups claim that not less than an estimated one million grade 10 completers failed to enroll in the K-to-12 program’s Senior High School, which added two years to secondary education and thus also to Filipino families’ expenses. Meanwhile, more than 1,200 private schools and state colleges and universities increased tuition.

Though PhilHealth now reportedly covers 93 million Filipinos, huge out-of-pocket expenses hound even sponsored patients. Meanwhile more than 70 public hospitals stand to be privatized. This is bound to make various health services more expensive, said IBON.

According to reports, the housing backlog was at 5.5 million and growing in 2015 . Meanwhile, big construction firms offer low-cost housing at rates that neither the unemployed nor the needy can afford, noted IBON.

The group said that government can revoke the privatization of basic social services and assume the responsibility of providing these to the people to ensure accessibility. With national industrialization as major strategy, this can be made possible by a self-reliant and self-sufficient Philippine economy that gives priority to feeding and nurturing the majority of its citizens over advancing the business interests of a few, IBON said.

From kmcmaggroup.com

“While there are sunny prospects, the 10-point agenda of neoliberal policies hangs over like a dark cloud,” said research group IBON’s executive director Sonny Africa yesterday at its political and economic briefing.

In its 2016 Midyear Birdtalk held at the University of the Philippines, IBON welcomed the Duterte administration’s opening of opportunities for pro-people measures to be pushed under its term. The group however also expressed concern that the government’s 10-pt economic agenda still invokes the neoliberal framework and may extend the same socioeconomic woes experienced under the past administration.

IBON reviewed the Aquino administration’s legacy which it described to be that of elite politics and economics. According to the group, Aquino continued and even advanced the same old neoliberal policies of past administrations, such as public private partnerships (PPPs) and enhanced trade and investment liberalization. Hyped rapid economic growth was exclusive, shallow, and slowing down. It did not contribute to long-term national development, resulted in worsening inequality, jobs situation and poverty, and further violated the country’s sovereignty, IBON said.

The group also discussed some of the new administration’s pro-people pronouncements, which provide possibilities for measures that could directly benefit the people. The Duterte government stated that it would end contractualization, stop demolitions, provide free public education, give free healthcare to the poor, give free irrigation, and release the coco levy fund to farmers, among others. Duterte also appointed progressives to the agrarian reform, social welfare, labor and poverty departments, and has shown openness to pursue peace talks with the National Democratic Front of the Philippines (NDFP), and the Moro Islamic Liberation Front (MILF).

However, the group also said that the administration’s 10-point economic ​agenda does not repudiate and plans to continue neoliberal policies and free trade agreements that have kept the nation backward. This includes pursuing and fast-tracking PPPs, and opening up the country’s natural resources, labor and markets to greater foreign exploitation through Charter change and lifting foreign restrictions. The agenda also does not indicate plans to reverse decades of privatizing education, health, housing and other social services, and fails to outline a production sector-based domestic jobs creation thrust, IBON noted.

In conclusion, the group emphasized the need for various people’s mobilizations to push for and advance national development and economic sovereignty. While supporting the Duterte administration’s pro-people pronouncements and initiatives, the mass movement can remain vigilant and continue to assert its demands for genuine social, economic and political change, said IBON.

Photo from CNN Philippines

The next presidency is challenged  to tackle a worst-ever jobs crisis, heightened inequality,and  pro-foreign and pro-business policies sown under Aquino’s leadership

 

Towards the end of its six years in office, the Aquino government boasted its legacy of inclusive growth. Indeed for its neoliberal thrusts the Aquino administration may have achieved certain economic outcomes. But for the Filipino people, an unprecedented jobs crisis, using public funds to guarantee private profits, an even wider gap between rich and poor and economic subservience to foreign dictates highlight Aquino’s brand of governance and economics. This is what the past administration has left behind and passed on to the next presidency.

Aquino, poster-child of neoliberalism

Throughout President Benigno Simeon Aquino’s term, the Philippines has time and again been hailed as one of Asia’s fastest growing economies. The 5.9% average growth rate in the past five years is undeniably strong-looking compared to past administrations’, notwithstanding slowdown in the beginning of 2014.

Foreign direct investments (FDI) in the country, which are believed to deliver employment and growth, have risen through the years under Aquino: US$2.0 billion in 2011, US$3.2 billion in 2012, US$3.7 billion in 2013, US$5.7 billion in 2014, and US$5.7 billion in 2015. Official employment figures indicate an increase from 93.6% in April 2015 to 93.9% to April 2016. Government also recently reported having lifted 1 million poor Filipinos from poverty.

These so-called achievements build up the image of the Philippines as the poster-child of neoliberal economics where the role of the free market in the control and use of resources, utilities and industries are given prominence. International financial institutions and credit agencies have periodically commended the Philippine economy’s stability amid global currents. Recently, NICE Investor Services raised the country’s investment grade from BBB- to BBB based on improved transparency, expanded infrastructure and social overhead capitals in the form of public private partnerships (PPPs). During the last Asia Pacific Economic Cooperation (APEC), high-level meetings held in the Philippines in November 2015, the Philippines was regarded among others as a model in disaster risk reduction, promoting micro, small and medium enterprises, maximizing the blue economy and human capital development.

Not felt by the people

The people’s worsening conditions however belie the Aquino government’s claims of inclusive growth. Growth mostly happened in sectors with heavy oligarch and foreign company investments such as the real estate, construction, business process outsourcing, and financial intermediation sectors. Farmers and workers could have benefited from growth in the production sectors but these have shrunk further under the Aquino administration, with agriculture’s share in the economy down to 9% and with manufacturing still on about the same level as it was decades ago, as of early 2016.

Even if FDI increased and employment grew, jobs creation has fallen from 1.1 million in 2011 to just 638,000 in 2015.  There has also been a 543,000 addition to the number of underemployed Filipinos in the same period, showing that there are now more temporary, low-paying and insecure jobs in the business-biased economy. Moreover, 63% of the total employed are non-regular, agency-hired, informal sector, or unpaid family workers. Wages have also been very insufficient: the P481 National Capital Region minimum wage, which is the highest across all regions, make less than half of the P1,093 family living wage or the amount needed by a family of six for subsistence. Aquino vetoed proposed increases in nurses’ salaries and the elderly’s pensions.

Despite almost P300 billion being spent on conditional cash transfers or the Pamilyang Pantawid Pilipino program (4Ps) from 2011-2016, the number of Filipinos in extreme poverty remains unchanged at 27 million as of the first half of 2015. More than 2 of 3 Filipinos live on just P125 or less per day which has become more difficult with the increasing cost of basic goods and services from food to transportation, education and health.

The Aquino administration continued a sham land reform program that further fortified large landowners’ landholdings, converted agricultural land to commercial purposes including big and foreign corporate plantations and  financialized land distribution. This has further entrenched tillers’ landlessness and poverty and ruined any prospects for food security. Aquino’s defiance of the Supreme Court decision to distribute the Cojuangco-Aquino-owned Hacienda Luisita to farmers remains the stark example of land non-distribution under the past administration. It also upheld a plunderous and destructive mining policy and merely sought greater government shares from mining revenues while more big local and foreign companies coveted resource-rich land. Worse, the Aquino administration did not heed calls to pull out abusive government troops from indigenous peoples’ and farmers’ communities such as those in Mindanao in spite of popular clamor.

Under Aquino, social services and utilities were further commodified instead of delivering the people’s basic needs. Because low-cost housing is a component of real-estate business, it remains unaffordable to many homeless Filipinos. Instead of strengthening the public school system to make education accessible to all, the Aquino administration allocated billions to private education and pushed K-to-12 to train cheap labor for the global market while allowing thousands of private schools to increase tuition. That PhilHealth coverage has reportedly grown to 93 million Filipinos does not guarantee to wipe out the huge out-of-pocket expenses shelled out even by indigent patients. Despite protests, Aquino allowed public hospitals like the Philippine Orthopedic Hospital and the Fabella Hospital, patients of which were mostly indigent, to be closed down. Meanwhile, privatized public utilities such as power and water remained espensive if not unaffordable and delivered in questionable quality to Filipinos.

Benefited the rich

At the end of Aquino’s term, majority of the Filipino people remain at the margins of apparent growth and international acclaim for the Philippines’ purportedly sound economics and governance. It is clear who benefited from the hyped improvements: under Aquino the net worth of the 40 richest Filipinos grew from 14% of the gross domestic product (GDP) in 2010 to 24% in 2015. The gross revenue of the top 100 corporations also rose from 59% of the GDP in 2010 to 69% in 2014. That the net income of the 25 richest Filipinos ($44.1 billion) is equivalent to the combined income of the country’s poorest 76 million Filipinos marks shows the grossly inequitable distribution of the nation’s wealth.

The Aquino government’s policies favored businesses over people’s welfare. The centerpiece PPP program for instance has allowed the private sector to profit immensely from people’s money even in public utilities and social services such as education, health and housing. Presidential uncle Eduardo Cojuangco’s San Miguel Corporation has bagged P149 billion-worth PPP contracts. Twelve projects worth P217 billion have been awarded to only a number of the country’s biggest business names aside from Cojuangco: Ayala, Pangilinan group, and Sy. The 2015 and 2016 national budgets allocated P53 and 66 billion, respectively to PPPs involving these oligarchs. Various sectors oppose these projects such as the MRT-7 construction and the Quezon City Business District that stand to displace farmers and urban poor settlers from their homes and livelihood.

Beholden to foreign dictates

Like its predecessors, the Aquino government’s economic policy was largely defined by foreign interests such as the US government and international financial institutions such as the World Bank (WB) and the Asian Development Bank (ADB). Of all the policy recommendations of US Agency for International Development (USAID)-funded The Arangkada Philippines Project (TAPP), 75% or 471 have begun or have been completed in 2015. The WB also used US$1 billion in development policy loans from 2006-2014 to push privatization in the health, education and power sectors and increase value added tax (VAT) and other taxes, among others.

The country has not benefited from free trade agreements (FTAs) such as the Japan Philippine Economic Partnership Agreement (JPEPA) and especially not from the World Trade Organization (WTO). The latter has inflicted damage on the country’s economy, particularly eroding the agriculture and industry sectors. Yet, the Aquino administration actively pursued FTAs that seek to further liberalize trade and investment, willing to abide by foreign countries’ impositions at the expense of public interest. It has actively sought the US-dominated Trans-Pacific Partnership (TPP) agreement and started formal talks for the European Union-Philippines (EU-PH) FTA. Through the Association of Southeast Asian Nations (ASEAN), it is also involved in the China-dominated Regional Comprehensive Economic Partnership (RCEP).

Not only once under the Aquino administration has easing restrictions to foreign ownership of strategic industries and sectors by altering Constitutional provisions been pushed. FTA especially TPP proponents have also recommended Charter change, described by nationalists as an affront to Philippine sovereignty.

Way forward?

Notwithstanding the anomalies and notoriety of Philippine automated elections, the results of the 2016 national polls reflected the Filipino people’s rejection of the Aquino administration’s elitism and pro-business policies. Evidences of bureaucrat capitalism through the priority development assistance fund (PDAF) and disbursement acceleration program (DAP), heightened human rights violations with a copied anti-insurgency program, neglect of overseas Filipino workers’ rights, undermining labor rights, selective prosecution of allegedly corrupt officials and allowing US imperialist aggression in legalizing a gravely lopsided defense agreement add to Aquino’s long list of offenses against the Filipino people, and for which he should be held accountable.

It is important to note that the newly-seated Duterte administration in its Ten-point Economic Agenda lists as priorities easing foreign restrictions, gearing human capital development to meet private sector needs, making PPPs play a key role in driving growth and promoting rural tourism. In these stipulations resonate the past regime’s unpopular measures. Yet, the list mentions plans that may suggest possible pro-people inclinations such as increasing rural productivity, making taxation more progressive by easing the burden on lower-income brackets, beefing-up social protection to be more effective in protecting the people against economic shocks, and directing science and technology as well as the creative arts towards self-sustaining, inclusive development.

The Duterte administration, whose electoral victory is attributed to the President-elect’s strong pro-people pronouncements, is challenged to do the opposite of what the Aquino government had done. Still, the neoliberal framework prevails. Big local and global corporate and political interests are intact and doing business as usual. On the other hand, strong public support for the resumption of peace negotiations which will tackle socio-eonomic reforms, and the people’s continued assertion of their rights, remains the constant force that will create the momentum for any genuine change. [end]

 

From cbsnews.com

​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.

For modernization?

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​

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