Politics

Preparing the public health system for the next pandemic

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A CHAPEL was converted into an intensive care unit for coronavirus disease 2019 (COVID-19) patients as hospitals struggled with a surge in infections in August 2021. — PHILIPPINE STAR/ MICHAEL VARCAS

By Patricia B. Mirasol, Reporter

BATTERED by the coronavirus disease 2019 (COVID-19) pandemic, the Philippine healthcare system has to shift to preventive care from “sick care” and shore up human capital in order to withstand the next infectious disease outbreak, health experts said.

The Philippines already has three viruses that are in the same family as pathogens identified by the World Health Organization as having “pandemic potential” — with a possible fourth on the horizon.

“There needs to be a lot of global coordination… for us to focus not just on reactions, not just on surveillance, but also at the complex drivers of zoonosis, such as climate change, pollution, and disasters,” said Noel Lee J. Miranda, a veterinarian and an independent regional consultant who specializes in emerging pandemic threats.

The Philippines is a party to the Pandemic Treaty, which aims to “strengthen pandemic prevention, preparedness and response.” The global accord initiated at the 2021 World Health Assembly will be negotiated in February this year and finalized by May 2024.

Recognizing the need for the “prompt identification and timely response to outbreaks,” the Department of Budget and Management has earmarked P419.3 million in 2023 toward the research and development (R&D) efforts of the proposed Virology Institute of the Philippines; and P25 million to construct a research center in the Visayas and an infectious disease laboratory in Mindanao (both are projects of the University of the Philippines System related to the Philippine Genome Center).

Two related pieces of legislation are in Congress: House Bill No. 9561, filed in September 2021, which seeks to establish a health security national action plan and strengthen institutional capacity for disease prevention, surveillance, control, and response; and Senate Bill No. 1801, filed in September 2020, which seeks to create a national action plan that addresses public health security and emergencies like the COVID-19 pandemic.

‘BUY YOUR TOOLS IN ADVANCE’Building up local manufacturing is also part of pandemic preparedness, said Ricardo Jose S. Guerrero, a research fellow of the Ateneo Research Institute for Science and Engineering, whose work includes the production of the proteins that are a component for diagnostic kits.

“As an engineer, I think it’s important to understand the current system before figuring out targeted interventions to solve identified issues,” he said in a Dec. 6 message on LinkedIn. “That’s also why I stress that there’s a lot that needs to be done systemically, and these will primarily be government policy-led to allow solutions to be implemented.”

R&D has limited visibility in government policy because it is “abstract,” he added. “If I have to procure a single chemical in Germany, there’s not much I can do,” he said in a Dec. 1 Zoom call. “R&D is such a small market. It takes weeks for shipping, weeks to months for things to get through customs… procurement is very bespoke.” 

“Technology is a tool. If you don’t buy your tools in advance… if you only invest in a hammer, when problems arise, you’re just stuck with your hammer — or you import en masse,” Mr. Guerrero said.

At the BusinessWorld Economic Forum last November, Jon Canto, co-managing partner for the Philippines at McKinsey & Company, said that the Philippines, as a net importer of pharmaceuticals, is vulnerable to supply chain disruptions caused by the COVID-19 pandemic.

Price variation and production inefficiencies could result in “poor quality of care” in 2023, he said in his presentation.

GIVE FRONTLINERS A LIVING WAGEHealthcare workers in the Philippines, despite being hailed as heroes after serving at the frontlines of the pandemic, still don’t get a living wage, said Monina A. Hernandez, an infection prevention and control clinical nurse specialist who continues to keep an eye on colleagues she left behind after leaving the country for greener pastures in 2010.

“Raise the salary of nurses,” said Ms. Hernandez, founder of the Filipino Nurses Association of New Zealand, Inc.

The health sector has been allotted a P296.3-billion budget for 2023, up from P268.4 billion the previous year; of this, P29 billion has been allocated for the procurement of medicines and vaccines, while P19 billion has been earmarked for the salary and benefits of healthcare workers.

A bill that proposes increasing the minimum base monthly salary of nurses in public medical institutions to P63,997 from P36,619 to encourage more licensed practitioners to stay in the country was filed in the House of Representatives last October.

For comparison, a newly qualified nurse can earn £27,055 in the United Kingdom, where Filipinos make up 24% of internationally trained professionals registered with the Nursing and Midwifery Council.

“Our educational system encourages all our graduates to leave the country,” said Ms. Hernandez. “It’s ingrained as early as high school…  What are the fastest ways to leave? One is nursing; another is teaching.”

The Philippines needs an additional 117,000 physicians and 126,000 nurses, the Department of Health (DoH) told BusinessWorld in a Viber message. Among the department’s proposed legislative agenda are the standardization of the salaries of human resources for health and an amendment of the incentives for barangay health workers.

“All of our decisions are centered on our families,” said Ms. Hernandez, who left the country for a better future. While creating nursing positions, offering competitive wages, and providing career development are steps in the right direction, she said that Filipino nurses who want to leave should be allowed to do so.

President Ferdinand R. Marcos, Jr., said last September that he plans to ease the restrictions imposed on nurses during the pandemic and, at the same time, “improve opportunities domestically.”

WORK WITH THE PRIVATE SECTORThe current health system, which is hospital-centered and specialist-oriented, is “sick care” and not healthcare, said former Health Secretary Dr. Manuel M. Dayrit, an adjunct professor at the Ateneo School of Medicine and Public Health.

“It does not do a good job of addressing the preventive and promotive aspects of health — which is about preventing disease, encouraging healthy lifestyles, and assuring healthy environments for people to live and work,” he told BusinessWorld in a Dec. 21 e-mail.

His recommendations for the next Health secretary include strengthening healthcare delivery and ties with the private sector.

The COVID-19 immunization rollout — which involved a tripartite agreement between the Philippine government, the private sector, and vaccine manufacturers — is an example of how public-private partnerships can address large-scale health concerns, he pointed out.

The 1991 devolution of public health services rendered the quality of healthcare across the Philippines uneven, said Mr. Dayrit. Meant to improve healthcare delivery, it had the “unintended consequence of fragmenting the government health sector.”

“Fundamental reform includes the strengthening of health services at the primary level, which is the weakest part of the country’s health system,” he said.