Published in Manila Standard Today
By Elizabeth Angsioco
It is budget season and in a few days, the Aquino administration’s proposed P1.816-trillion proposed budget for 2012 will be approved. Of this amount, the Department of Education has the biggest share of P237 billion. Next is the Department of Public Works and Highways with P125.9 billion.
In terms of budget increases, the Department of Social Welfare and Development enjoys the biggest increase (56 percent), from 2011’s P34.3 billion to 2012’s P53.6 billion. The bulk of the DSWD budget will go to the conditional cash transfer program that has an allocation of P39.4 billion.
Now, where is the Department of Health in the scheme of things? DoH has a proposed 2012 budget of P42.7 billion; it also enjoyed a substantial increase from 2011’s P31.8 billion.
However, if we look closely, the entire health budget is only P3 billion more than the CCT program of the DSWD. I sense something wrong here.
Philippine National Health Accounts (2007) data on “Distribution of Health Expenditure by Source of Funds” indicate that private out-of-pocket funds accounted for 54.3 percent of total moneys used to access health services. Local government shared 13.3 percent, national government—13 percent, other private sources—10.5 percent, and Social Health Insurance (PhilHealth)—8.5 percent. Concretely, this means that people, rich or poor, pay for their health needs.
If we look at family expenditure on health (Family Income and Expenditure Survey 2006), we will see that families spend 45 percent on drugs and medicines, 28 percent on medical charges, 21 percent on hospital room charges, and 6 percent on other medical goods.
The question begging to be asked is: how do our poor citizens address their health needs? This especially with the DoH 2008 data saying that almost 80 percent of those in the lowest economic quintile, 70 percent of those in the second lowest, and 60 percent of those in the middle, are not covered by PhilHealth.
In such a situation, it is the poor who suffer. Moreover, it is the poor women, tasked by society to take care of their families, who suffer the most. Do we wonder why poor women tend to neglect their own health? Does it surprise us that their reproductive health is at times the least of their concerns?
The DoH is supposed to take care of our people’s health. But with very limited budgets, how will it succeed?
The National Statistics Office projects a Philippine population of 97,594,040 for 2012. This is the number of Filipinos the DoH should provide health services for. Thus, in actual terms, the department’s budget is P437.46 per Filipino per year or a measly P1.20 per Filipino per day! Yet, government is spending an almost equal amount for its dole program.
In relation with budgets for family planning which is loudly protested by anti-RH bill groups, the DoH budget is severely wanting. All credible surveys through the years have clearly established that the big majority of Filipinos want a government-funded family planning program to be implemented.
In the DoH 2012 budget, an allocation of P2.5 billion for Family Health and Responsible Parenting is included. However, of this amount, per the Special Provisions of the department’s budget, P1.75 billion has already been reserved for the procurement of vaccines for senior citizens.
This leaves P750.6 million for the entire program. This amount is NOT all for family planning because the program also includes these services: pre-pregnancy, child, mother and newborn, adolescent, men’s health, older persons, cross-cutting concerns, procurements, monitoring and evaluation, and support to Local Government Units health programs. If we go by the 2011 experience, the amount that will be left for contraceptives will only be around P100 million. The DoH, in the 2011 budget deliberations, said that it needs approximately P1.2 billion to respond to the unmet need for family planning. Certainly, the P100 million is way too low.
To further illustrate, of the projected 2012 Philippine population where 48.5 million are women, and we take from this the 46 percent (based on 2007 NSO Population Census) of women’s population who are of reproductive age (15 to 49 years old), we will have 22.3 million such women. With a P100 million allocation for contraceptives, DoH will have a budget of P4.48 per woman per year or P0.012 per day per woman!
I can almost hear voices protesting: Why spend for contraceptives when government can hardly provide for people’s health? The answer is quite simple. Family planning is directly related with health, particularly, women’s health.
If those who want to practice family planning are able to do so, risky (too early, too frequent, and too late) pregnancies will be prevented. Thus, pregnancy and childbirth complications will drastically decrease. The same is true for abortion complications because if pregnancies are planned, abortion will not be resorted to.
World Health Organization and DOH studies show that an effective family planning program can reduce maternal mortality by about 35 percent, maternal morbidity by 50 percent, and abortions by up to 85 percent. Thus, family planning is a health issue.
Further, family planning for those who want it also makes for a sound economic investment. Guttmacher Institute and University of the Philippines Population Institute studies indicate that the Philippines presently spends a total of P9.3 billion (public and private funds) for maternal care, including family planning. This is broken down as: P1.9 billion for family planning supplies and services; P3.5 billion for medical care for unintended pregnancies/complications; and P3.9 billion for medical care for intended pregnancies.
If we increase expenditures for family planning to P4 billion (modern method used by all at risk), medical care for unintended pregnancies/complications will go down to P6 billion while amount for intended pregnancies will be the same. Total expenses will be P8.5 billion, enabling government and people to save P8 billion.
Money for people’s health, alongside education, is the best investment government can make to improve people’s quality of life. “Health is wealth” may be a cliché but it is quite valid especially in the Philippine context.
Addressing women’s reproductive health needs is a government responsibility. Because it is unable to do this, women’s and other organizations are helping out. Fortunately, there are some groups who assist us in this work.
Isn’t it a shame that others hear our women’s pleas for help while some in our government choose to ignore, even malign us? As Dr. Junice Demeterio-Melgar, Executive Director of Likhaan said, for as long as government is unable to do its responsibilities on reproductive health, we will continue what we do.