Better Days

Senator Sonny Angara

With the COVID-19 pandemic still raging, many can’t help but ask how some countries were able to curb the deadly disease while others struggled (and continue to struggle) to do so and prevent exponential loss of life and livelihood. In this regard, a recent article in The New Yorker about Costa Rica’s public healthcare system could prove to be informative.

The article first highlighted how Costa Rica has a life expectancy approaching 81 years old, which is much higher than ours at 71 years old, and even that of the United States’ at 79 years old. What is remarkable about the Latin American country was that it was able to ensure the longevity of its people, with a per capita income that is only a sixth that of the United States—an apparent exception to the trend where national income tracks closely with life expectancy.

In fact, a 2008 US National Center for Biotechnology Information (NCBI) publication stated that the mortality of 90 year-old Costa Ricans was “at least 14% lower than an average of 13 high-income countries.” Considering that the country’s life expectancy was only 55 years in the 1950s, Costa Rica has indeed come a long way.

How is the country able to take care of its citizens so well? According to the article, this can be primarily attributed to early investments made into public health. Early on, Costa Rica prioritized vaccinating their population against polio, diphtheria and rubella as well as ensuring that newborns, new mothers, and pregnant women are provided with care and nutrition since their government was able to identify that maternal and child deaths were the “biggest source of lost years of life.”

Even now, Costa Rica has maintained a high regard for health care—investing 7.5% of its GDP for health expenditures in 2018. In comparison, during the same period, the Philippines’ health expenditure only accounted for 4.4% of GDP.

What appears to be exceptional about Costa Rica isn’t really the amount, but the kinds of investments it made in public health. As early as the 1990s, Costa Rica was already moving towards the implementation of a form of universal health care coverage to merge public health services with healthcare institutions, integrate health records across the entire system, assign every citizen to a primary healthcare team, and mobilize community health workers to deliver services directly to households whenever needed. All these reforms resulted in the improvement of living standards and a considerable drop in mortality rates.

In 2019, the Universal Health Care (UHC) Law (RA 11223) was enacted, containing similar reforms seen in Costa Rica such as the integration of local health systems within local government units (LGUs). This also included the registration of every Filipino with a public or primary healthcare provider of choice, aimed at promoting their health-seeking behavior but also detecting diseases early on to prevent them from worsening. Though the law’s full implementation has been delayed due to COVID-19, there is great hope that the reforms under it will result in a stronger and more efficient — and perhaps more pandemic resilient — health system much like Costa Rica’s.

But even with this delay, we believe there are some pointers that can be picked up from Costa Rica’s experience particularly in response to the COVID-19 pandemic. For instance, a pressing concern is the vaccination of Filipinos, particularly seniors and persons with disabilities (PWDs). Currently, they are asked to line up together with many others in vaccination sites. Given their vulnerable state, it should be the objective of the government to ensure that this sector is protected.

In Costa Rica, not only are local healthcare teams involved in scheduling vaccination appointments, they are also responsible for personally visiting households assigned to them to deliver basic services whenever needed. In the Philippines, our barangay health workers could take on this responsibility for the vulnerable sectors since they can be trained to administer COVID-19 vaccines and monitor recipients. They could also serve as “embedded” contact tracers that are able to track more closely who gets sick, given their more personal ties to the community.

If anything, Costa Rica has shown how better health outcomes need not be fully dependent on a country’s income. They demonstrate how a developing country like the Philippines can improve its people’s health with limited resources. And that allows us to remain hopeful that with the full implementation of the UHC law as well as the other investments in our health system in light of the ongoing pandemic, our country would be able to not only curb COVID-19 but also build a better and healthier community.

Sen. Sonny Angara has been in public service for 17 years. He has authored and sponsored more than 200 laws. He is currently serving his second term in the Senate.

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