FROM THE MARGINS

Today is Labor Day, a national holiday honoring Filipino workers. Philippine Labor Day was first celebrated on May 1, 1903, when more than 100,000 workers organized by the Union Obrera Democratica de Filipina – the country’s first labor organization – marched from Tondo to Malacañang to demand fair wages from the government. Five years later, in 1908, the law declaring May 1 as a national holiday was passed. Much has been done to protect the rights of workers in the Philippines. Still, ensuring a living wage, better working conditions and basic human rights like health are continuing challenges.

Poverty and health

Poverty and poor health are inextricably linked, hounding Filipino workers and other marginalized sectors. The 18.1 percent poverty incidence in PSA’s 2021 FIES Survey translates to 19.9 million Filipinos living below the poverty threshold. The 3.9 percent subsistence incidence among families is equivalent to 1.04 million poor families who do not earn enough to meet even just their basic food needs.
Despite the passage of RA No. 11223 or the Universal Health Care Law, majority of the poor still do not have access to basic health care. According to DOH, 70 percent of people in rural areas are still struggling with limited access to health care services. A PIDS study in 2020 revealed a shortage and maldistribution of health care workers: doctors, nurses, and midwives tend to work in areas where earnings are potentially high and near communities where they were trained.  This leaves 75 percent of cities and municipalities with insufficient number of health workers.  This was confirmed just last week by Ibon Foundation, which reported that the poorest regions with the greatest health needs have the least developed health services.
The majority of our workforce are minimum wage earners or informal sector workers, hardly earning enough for basic necessities. Social health insurance through PhilHealth provides relief in case of hospitalization, but poor households’ medical expenses are mostly out-of-pocket, discouraging them from seeking medical care.

Addressing disparities

Addressing poverty, inflation and unemployment is crucial to ensuring the poor’s access to health. Aside from putting in more resources to strengthen the public health care system and improving PhilHealth, the government needs to promote health insurance and microinsurance.
Pushing for social and financial inclusion necessitates giving poor people access to affordable insurance products. Non-life insurance which include health is expensive in the Philippines compared to other ASEAN countries because insurers pay, on top of their income taxes, about 27 percent in various taxes for every insurance policy that they sell. Lowering the tax will make non-life insurance more affordable. It will also encourage more commercial insurance companies, microfinance institutions (MFIs) and mutual benefit associations (MBAs) to offer microinsurance health products for the poor.
Apart from encouraging private hospitals and clinics to expand to the countryside, the government could work with heath cooperatives, such as the Medical Mission Group (MMG) Federation, which is a secondary health care cooperative with 19 members. They provide affordable health services to underserved communities and offer health education, wellness programs and other community-based resources to promote preventative health care.
The government should also support MFIs, as many of them have integrated health in their microfinance programs, providing millions of clients with much-needed services, such as health education, clinical care, health financing, and even medical missions in far-flung communities.  Further, MBAs with financial capability should be allowed to invest and/or establish their own clinics, laboratories, and mini-hospitals to serve their members.
To address the shortage of health professionals in far-flung areas, the government could adopt measures such as: expanding medical volunteer programs that facilitate the deployment of medical students to serve hospitals in the barrios; allowing qualified nurse practitioners supervised by a doctor to prescribe medicines and perform basic medical functions (like in the US); allowing one pharmacist to supervise five assistant pharmacists deployed in pharmacies within a 10 kilometer radius; training med tech assistants, who can handle basic laboratory testing under the supervision of one medical technologist.

Making health care accessible

Aside from encouraging more private sector investment in health care facilities, the government could tap community-based organizations, like health cooperatives, MFIs and MBAs, to complement the services provided by local health centers.
MFIs can do their share by aggregating their resources under the leadership of the Microfinance Council of the Philippines, Inc. (MCPI).  It has been done before through the “MFIs for Health” Program, a collaboration among MFIs that served more than four million clients nationwide. MFIs can go one step farther, by sharing resources to establish hospitals, clinics and pharmacies in strategic areas. Imagine the impact: the MCPI’s aggregate microfinance clients number around 12 million families, translating to about 40 million lives that can be helped!  That the facilities will be owned by MFI clients is a testament to true people empowerment!
Let us make health services available to the poor. As stated by Ibon Foundation’s Sonny Africa: “Health care should be provided according to need,  and not mainly on the basis of who can afford it.” *(Dr. Jaime Aristotle B. Alip is a poverty eradication advocate. He is the founder of the Center for Agriculture and Rural Development Mutually-Reinforcing Institutions (CARD MRI), a group of 23 organizations that provide social development services to eight million economically-disadvantaged Filipinos and insure more than 27 million nationwide.)*