Transcript Philippine Health Care Status:

The Philippine Health
Care System: An Update
Jaime Z. Galvez Tan, MD, MPH
[email protected]
+63917 853 7798
A Community Participatory Exercise
On a separate sheet of paper,
write one word that you feel
would best describe the
Philippine Health Situation
The Philippines 2006
Trends in Population and
Development
At 2.36%
population growth
rate:
2 M annual
increase in
population or
5,479 per day
increase
206 babies born
every hour or 4
every minute
85 M estimated
population at the
end 2005 (NSO)
High population growth rate
The Good News…..
BUT
Infant Mortality Rate
per 1000 live births
100
80
60
38.4
36
1993
1998
40
30
20
0
Year
Source: National Statistics Office, 2006
2003
Child Health
declining
but still
higher than
other
Southeast
Asian
countries
Infant Mortality
…
Per
Thousand
140
120
100
80
60
40
20
0
1950-55
1995-2000
Philippines
100
35
Thailand
132
29
Korea
115
10
Maternal Mortality Ratio
250
209
Ratio
200
172
150
100
50
0
1998
1993
Year
Source: National Statistics Office, 2006
Maternal Mortality Across Asian Countries
172
200
160
106
150
95
80
100
4
50
0
Phils.
Viet.
Thai.
China Malay. Singa.
Source : 1998 NDHS, US Census, Thai Health Police
Trends in the Prevalence of Malnutrition
among 0-5 Year-Old Children,
Philippines 1989-90 to 2003
45
39.9
36.8
40
34.3
34.5
34.0
35
31.4
% prevalence
34.5
29.9
34.0
30
29.9
25
30.8
32.0
Stunting
30.6
20
Underweight
26.9
Wasting
15
5.0
6.6
Overweight
6.7
5.2
10
6.0
6.3
5.3
0.6
5
0.7
0.4
0.5
0.4
1.0
0
1989-90
1992
1993
1996
1.4
Overweight
Wasting
Stunting
Underweight
1998
2001
2003
Yes Declining Malnutrition but…
A cohort of 3.3. million children 0-5
years old remain in chronic
malnutrition throughout their preschool years.
This means one fourth of Filipino pre-school
children are always at high risk of mental
and physical retardation.
Trends in the Prevalence of Malnutrition
of 6-10 Year-Old Children,
Philippines 1989-90 to 2003
50
44.8
42.8
42.2
45
40.8
39.1
41.1
40
34.2
% prevalence
35
35.8
32.5
32.9
30.5
30
28.3
30.2
25
25.6
Stunting
20
Underweight
15
Overweight
0.1
10
0.2
0.6
0.4
n
0.8
5
0
1.3
Overweight
1989-90
Stunting
1992
1993
1996
Underweight
1998
2001
2003
Yes among elementary school
children, declining malnutrition
but…
A cohort of 3.6 million school children age 6
to 10 years old remain in chronic
malnutrition during their school years. They
would likely not perform well and most
likely drop out.
This means one fourth of our future work force will
be physically and mentally deficient.
Proportion of Mothers Delivered By A Health
Professional
Proportion
100
80
59.8
60
40
28.2
34.2
20
0
1993
1998
Year
Source: National Demographic and Health Surveys ; National
Statistics Office, 2006
2003
Proportion of Mothers Delivering at Home
100
Proportion
80
71.5
65.5
61.4
1998
2003
60
40
20
0
1993
Year
Source: National Demographic and Health Surveys; National Statistics
Office, 2006
Quality of Antenatal Care 2003
Percentage of women who received the following
during antenatal care:
 Blood sample taken – 37.6
 Urine sample taken – 46.7
 Informed of signs of pregnancy complications –
49.1
 Height measured –
59.7
 Weight measured –
87.9
 Blood pressure taken – 90.3
Now
The Bad News……
Death by Attendance in 5-year Intervals, Philippines 1965-2002
100%
90%
80%
70%
Percent
60%
50%
Unattended
40%
Attended
30%
20%
10%
0%
1965
1970
1975
Source: National Statistics Office, 2006
1980
Year
1985
1990
1995
2000
2002
Proportion of Infants Exclusively Breastfed
100
Proportion
80
60
57.7
40
42.7
40.1
20
26.4
13.2
20
<2 months
52.5
2-3 months
35.4
4-5 months
16.1
0
1993
1998
Year
Source: National Demographic and Health Surveys; National Statistics
Office, 2006
2003
Proportion of Fully Immunized Children
100
Proportion
80
69.4
58.2
65.3
64.5
65.2
1998
1999
2000
61.3
62.9
59.9
2001
2002
2003
60
40
20
0
1993
1997
Year
Source: National Statistics Office, 2006
Vitamin A Deficiency: a major cause of childhood
illnesses and deaths
45
38
1993
1998
2003
40
35
40.1
35.3
30
25
20
15
10
10.4
8.2
8.5
5
0
Deficient
SR< 10 ug/dL
Deficient and Low
SR < 20 ug/dl
Prevalence of Vitamin A Deficiency among 6m – 5y old children, 1993- 2003
Anemia: a major cause of poor school performance
and school drop-out
70
65.9
60
50
1993
1998
2003
56.6
49.2
42.0
35.6 37.4
%
40
29.6 29.1
30
25.7
20
10
0
6 mos - < 1 y
1-5y
6 - 12 y
Prevalence of anemia among children: 1993, 1998, and 2003
Expenditures for Medicine within the Mean Health
Expenditure
300
250
200
$ 150
100
50
0
Bottom 30%
Middle 30%
Income Class
Source: The Filipino Poverty Report Card, World Bank, Social
Weather Station 2001
Top 40%
Why the Good News but….
Why the Bad News….
An analysis of the some of
the immediate causes
Proportion of the Health Budget in the Philippine
National Budget
3
2.53
2.5
2.03
2
1.84
1.81
1.55
1.6
1.4
% 1.5
1.1
1
0.5
0
1998
1999
2000
Source: National Statistical Coordination Board, 2005
2001
2002
Year
2003
2004
2005
Percentage Share of Health Expenditure to GNP,
Philippines, 1991-2003
3.5
3.4
3.2
3
2.9
3.4
3.5
3.4
3.2
3.3
3.2
3
2.9
2.9
2.7
2.5
2
%
1.5
1
0.5
0
1991
1992
1993
1994
Source: National Statistical Coordination Board, 2005
1995
1996
1997
Year
1998
1999
2000
2001
2002
2003
Local Government Health Expenditure
444.12 445.16
billion US dollars
500
400
316.84
300
174.52
200
100
208.6
346.78
387.02
356.76
249.58
118.7
27.6
34.58
0
1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002
Year
Source: National Statistical Coordination Board, 2005
Philippine Health Insurance Program, 2003
43%
27%
Non-members
15%
Privately Employed
Government Employed
Individually Paying
Indigents/Sponsored
OFWs
11%
2%
2%
70%
Source: NDHS, 2003
Others
YEAR
VOLUME
1994
6,699
1995
7,584
1996
4,734
1997
4,242
1998
4,591
1999
5,413
2000
7,683
2001
13,536
2002
11,911
2003
18,450
TOTAL
84,843
Average (10year period)
8,931
nurses/year
If all data accounted for, at least
100,000 Nurses left in the last 10
ten years – the highest volume in
history
Deployment of Filipino Nurses, 1994-2003
20,000
18,000
16,000
14,000
12,000
10,000
8,000
6,000
4,000
Note: full USA data not
accounted for
Source: Professional Regulation
Commission, 2004
2,000
0
1994 1995 1996 1997 1998 1999 2000 2001 2002 2003
VOLUME
Nursing Licensure Board Passers
Year
board passers
Source: PRC, 2005
05
20
20
03
20
02
20
01
20
00
20
44.75
51.6
48.18 49.68
04
53.5
49.86 49.2
99
19
19
19
55.79
98
50.02
97
54.22
96
19
19
19
58.24
95
61.45
94
70
60
50
40
30
20
10
0
Performance of Schools in the NURSING Licensure Examination,
1994-1998, 2001, and 2002
YEAR
1994 - 1998
Passing Rate
of less than
50%
68
2001
2002
%
%
Total
38%
Passing Rate
of 50% &
above
113
62%
181
116
48%
124
52%
240
150
63%
87
37%
237
160
140
113
120
116
124
100
80
Source:
Calculated,
PRC Data,
2004
150
87
68
60
Passing
Rate of
less than
50%
Passing
Rate of
50% and
above
40
20
0
1994 - 1998
2001
2002
Nursing Board Performance
YEAR
Number
of Examinees
% Increase
Number
of Passers
% Increase
Passing
Rate
1994
41,459
-
25,477
-
61.45
1995
38,689
-7%
22,532
-12%
58.24
1996
25,163
-35%
13,643
-39%
54.22
1997
19,546
-22%
9,776
-28%
50.02
1998
17,101
-13%
9,541
-2%
55.79
1999
13,152
-23%
6,558
-31%
49.86
2000
9,270
-30%
4,601
-30%
49.63
2001
8,269
-11%
4,430
-4%
53.57
2002
9,449
14%
4,228
-5%
44.75
2003
15,606
65%
7,526
78%
48.23
2004
25,294
62%
12,581
67%
49.74%
2005
50,280
Average
(12-year
period)
22,785 examinees/year
Source: Professional Regulatory Commission, 2004
25, 951
51.60%
12,267 registered nurses/year
The Phenomenon of
Doctors Becoming
Nurses
“Nursing Medics”
Only in the Philippines before 2005
(now no more)
Doctors Becoming Nurses



Around 3,000 doctors have left as nurses since
2000
In 2003-2005, more than 4000 physicians took
the Philippine Board of Nursing Licensure
Exams
Currently around 3,000 doctors are enrolled in
45 nursing schools offering customized courses
for physicians all over the country
Nursing Medics: Who Are They?






Around 80% of government physicians have taken up
or are enrolled in nursing
They come from all kinds of specialties
Their age range from 25 years old to 65 years old
Years of practice as a physician range from zero to 38
years
More females than males;
They come from all regions of the country
Source: KII, Personal Study 2004
Consequences Series #1



Decline in the interest of young Filipinos to
study medicine – evidenced by a drop of 50% in
NMAT examinees with 2001 as baseline
Decline in the enrolment in medical schools –
an average of 30%; 3 medical schools have
closed down
Decline in the applicants for medical residency
positions to become specialists
NMAT Examinees (1994-2004)
4000
40
70
44
75
58
53
61
92
62
45
61
21
59
48
57
30
53
60
5000
50
49
Examinees
6000
58
14
7000
3000
2000
1000
0
1994
1995
1996
1997
1998
1999
Year
Source: CEM, 2004
2000
2001
2002
2003
2004
Overseas Filipino Workers (OFWs) Remittances
YEAR
US$
1999
US$ 6.79
2000
US$ 6.05
OFW Rem ittance in Billion US Dollars, 1999-2005
12
10
2001
US$ 6.03
8
6
2002
US$ 7.19
4
2003
US$ 7.64
0
2004
US$ 8.50
2005
US$ 10.2
Source: Central Bank of the Philippines, 2005
2
1999
2000
2001
2002
2003
In Billion US$
2004
2005
NMAT
NMAT Examinees (1994-2005)
7000
6000
5000
5814
5049
5360
5730
5948
6121
6245
6192
5853
4475
4070
4000
3000
2912
2000
1000
0
1994
1995
1996
1997
1998
1999
2000
2001
2002
2003
2004
2005
2006
Consequences Series #2




200 hospitals have closed down within the past
two years – no more doctors and nurses
800 hospitals have partially closed (with one to
two wards closed) – lack of doctors and nurses
Nurse to patient ratios in provincial and district
hospitals now 1: 40 to 1: 60
Loss of highly skilled nurses in all hospitals
across the country
Why these bad bad sad sad
news!
An analysis of the some of the
major underlying causes
Income
 Annual
average family income: US$2,619
(FIES 2000)
 Poverty incidence: 34% or 25.8 million
people (NEDA 2001)
 Poverty Self-Rating by Filipinos:
March 2001: 64% are poor (50 M)
Oct 2005: 75% are poor (64 M)
(Pulse Asia Surveys 2001-2005)
Philippine Per Capita Gross National Income
1080
1080
1070
1060
1050
1040
1040
1030 1030
1030
1020
1020
1010
1000
1998 1999 2000
2001
Source: WDI Online, World Bank
2002
In US Dollars
Employment
 Total
labor force: 35 Million
 Total Unemployment Rate: 10.1% (LFS
Oct. ’03)
 Total Underemployment Rate: 15.7% ( LFS
Oct. ’03)
Unemployment Rate, Philippines 2003
12%
10%
8%
6%
4%
2%
Source: http://www.bsp.gov.ph/statistics/spei/tab46b.htm
2001
2003
Year
1999
1997
0%
ne
s
Pn
ilip
pi
sia
on
e
In
d
et
na
m
Vi
Th
a
ila
nd
a
al
ay
si
M
Si
ng
a
po
r
e
World Economic Forum
Global Competitiveness Report
Corruption Index Ranking
1 = Least Corrupt
0
10
20
30
40
50
60
70
5 5
2002
34 39
43
2003
45
80
90
100
2002: Rank out of 80 Countries
68
61
77
76
88
92
2003: Rank out of 102 Countries
National Budget
 Budget
deficit 2004: US$5B or 35% of the
national budget
 % of National Budget for debt servicing:
30%-45% (2002-04)
What Can NGOs and POs Do About
the Situation?



Advocacy Based Strategies
Local Government Based Strategies
Community Based Strategies
Advocacy Based Strategies #1
Lobby for national policy coherence in health
human resource development (HHRD).
Lobby (text, write, email, call) the heads of the 15
government agencies involved in HHRD to
regularly meet and speak with ONE voice.
These are: DOH, DOLE, POEA, OWWA,
CHED, PRC, PhilHealth, PITAHC, DOF, DFA,
NEDA, DBM, TESDA, DOST, DTI
What NGOs & POs can do?













Convergence
Partnership
Budget Involvement
Monitoring/quality standard
Community Management/community based
Policy involvement
Political Reform/Good Politics
People empowerment in governance
Development of indigenous resources
More women leaders
Community awareness/education for all
Health empowerment
equity
The Extra Challenge
NGOs, POs and Communities
Can Do It !!!!!!
Let’s Do It NOW !!!!!
Thank You Very
Much!!
Maraming Salamat Po!
Jaime Z. Galvez Tan M.D., M.P.H.
[email protected]
+63917 853 7798 mobile
Comparison in the Prevalence of Malnutrition Between
1998 and 2003 among 6-10 Year-Old Children
LEGEND:
50
40.8
% prevalence
40
30.2
30
36.5
1998
Underweight
2003
1998
Underheight
2003
26.7
Overweight
1998
2003
20
10
n
0
1998
2003
1998
2003
1998
1.3
2003
Under-five Mortality Rate
100
Rate
80
63.5
54.9
60
42
40
20
0
1993
1998
Year
Source: National Statistics Office, 2006
2003