philippine situationer: global health course 2010

8/9/2019 Philippine Situationer: Global Health Course 2010

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The PhilippinesNational Health Situation


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The Philippines is an archipelago of

,7 107 islands with,a total land area

including inland,bodies of water of

approximately,300 000 square

kilometers

( ,116 000 square

).miles

Its,36 289 kilometers

( , )22 549 miles of coastline makes it the country with the 5th longest

coastline in the.world


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(Dry Season March)to May

( Wet season June) to November

Averaging 20 or

more typhoons Cold Season

( - )December February


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Located in the

Pacific Ring of Fire and is exposed to

almost the full array of natural( ,hazards earthquakes, ,typhoons landslides

, .)floods etc

Ongoing complex emergency in

southernmost island of Mindanao

Highest number of disasters per( )country in 2009 26


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POpulation

Aug 2007: 88.57MProjected 2010 population: 94.01M2.04% annual growth rate (2000-2007)

More than doubled in less than 40 years!(1970-2007)


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POpulation

Aug 2007: 88.57MProjected 2010 population: 94.01M2.04% annual growth rate (2000-2007)

More than doubled in less than 40 years!(1970-2007)


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Political system

Recently concluded itsfirst automatedelection last 10 May2010

The country is made up of political localgovernment units of provinces, cities,

municipalities andbarangays (villages).

Local Government Code of 1991


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Economy

GDP (2009) = Php 161 Billion (2.8BEuro)

GDP Growth in 2009: 1.8% (Q4), 0.9%(annual) from 3.8% in 2008


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Economy

69 million Filipinos (80% of population)struggle to survive on Php 96 (1.3 Euro) orless a day

46 million Filipinos go hungry every day

(i.e., unable to meet minimum nutritionalneeds)


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Wages are not enough tosustain a decent life.

:June 2008 iving Wage ------------------------------- . (P 911 00 16

)Euros

( , NCR family of 6 according to the Nat l Wages)and Productivity Commission

aily Minimum Wage ---------------- . ( .P 382 00 6 7)Euros

( , )NCR including COLA

--------OT ENOUGH . ( .P 529 00 9 3)Euros

Prices of basic goods are rising faster than wages.


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While the rich are getting richer

Net worth of 10 richestFilipinos:

US$12.4 billion or 10B Euro(2006)

Equivalent to the combinedannual income of poorest9,600,000 families

(approximately 49million Filipinos)

(Ibon Databank 2007)


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Number of Unemployed

POEA data

2.3

2.6

3.2

3.8

Cory Ramos Erap Gloria

Number of unemployed (millions)

1987-1991 1991-1997 1997-2000 2001-2008


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Migration

POEA data

361,833469,709

693,815

1,008,303

Cory Ramos Erap Gloria

Number of migrant workers deployed yearly

1987-1991 1991-1997 1997-2000 2001-2008


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Decreasing self-sufficiency in foodproduction, including rice

-1.5

-1

-0.5

0

0.5

1

1.5

2

80 81 82 83 84 85 86 87 88 8 9 90 91 92 93 94 95 96 97 98 99 00 01 02 03 04 05

$ B

Balance of trade in food 1980-2006

Pinaghalawan: WTO online database

1980 (1.41)

1995 (-0.14)

2006 (-0.49)


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Spending for health

Total Health Expenditure is 3.7% of GDP(less than WHO recommended 5%)

38% (?) of population has PhilHealthCoverage (NDHS 2008)

Most (46.4%) of the family expenditurefor health goes to drugs & medicines

Philippines drug prices are 3.4 to 184times the international referenceindex.


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Spending for health

.o t a l H e a l t h E x p e n d i t u r e P 0 2 5 p e r i l i p i n o p e r d a y

59% outof pocket

23%government

18% Shared-

Risk SchemesIncludingNational HealthInsurance(PhilHealth)


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Average spending in nationalbudget per admin (% of GDP)

Aquino Ramos Estrada

Arroyo

Education .2 7 .3 1 .3 7 .2 7Health .0 7 .0 5 .0 5 .0 3Housing .0 0 .0 1 .0 2 .0 1Defense

.1 3 .1 3 .1 1 .0 9 ebt service( &nterest

)r incipal

.8 9 .6 8 .6 6 .10 1


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Average sectoral allocation innational budget per admin (%)

Aquino Ramos Estrada

Arroyo

Education .12 3 .15 5 .18 7 .15 1Health .3 1 .2 6 .2 4 .1 8Housing .0 1 .0 6 .0 8 .0 4Defense

.6 1 .6 7 .5 6 .5 0 ebt service( )nterest only

.40 0 .25 3 .19 2 .25 2


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Debt service always atexpense of social services (1)


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Worsening State Neglect


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National Budget picture for 2010

DEBT SERVICE - INTEREST PAYMENT 17.94%

EDUCATION 10.47%AGRICULTURE 2.22%ARMED FORCES 1.98%HEALTH 1.6%

Total National Budget: Php 1.54T (27BEuros)


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700

,0 000

Average Life Average Life Expectancy of Expectancy of(Filipinos in (Filipinos in

)years )years

Filipino Babies dying of PREVENTABLE causes

ANNUALLY


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Indicators

CBR: 20.5 / 1000CDR: 4.8 / 1000Healthy Life Expectancy (HALE): 62 (M:

59 years, F: 64 years) (WHS 2010)


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IN FA N T M O RTA LITY R ATE

Decline in IMR between 2003 and2008 is statistically insignificant

(NSO)

( )DHS 2008

(Galvez-Tan, 2009)(Galvez-Tan, 2009)


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UNDER-5 MORTALITY

Survey Year

Approximatecalendar

period

Under-five mortality

Rate StandardError

95%ConfidenceInterval

Lower bound

Upper bound

1993 1988-1992 54.2 - - -

1998 1993-1997 48.4 2.8 42.7 54.1

2003 1998-2002 39.9 2.8 34.4 45.5

2008 2003-2007 33.5 2.5 28.6 38.5

Table 1. Trends in childhood mortality rates, with standard errors and confidence intervals, Philippines Sources: 1993 National Demographic Survey, 1998, 2003 and 2008 National Demographic and Health Surveys


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M AT E R N A L M O R TA LITY R ATIO

Between 1990 and 1998, the improvement ratewas 14% while that between 1998 and 2006 wasonly 6% , an almost 50% drop

(Galvez-Tan, 2009)(Galvez-Tan, 2009)


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LEB over LEB over 800 yearsyears IMR less than IMR less than 100 MM less than MM less than 155

LEB underLEB under 0 0 yearsyears IMR over IMR over 900 MM over MM over 15050


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butbut 70%70% of Filipinos haveof Filipinos have no accessno access totoessential drugs.essential drugs.

There are moreThere are morethanthan 16,00016,000registeredregistered

medicine in themedicine in thecountrycountry

ACCESSCCESS

WHO World Medicines Situation, 2004


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Health Human ResourceS

No. 1 Exporter of Nurses An estimated 85% of employed Filipino

nurses (more than 150,000) are workinginternationally. (Aiken et al 2004)

70% of all Filipino nursing graduates areworking overseas. (Bach 2003)

No. 2 Exporter of Doctors68% of Filipino doctors work overseas, next

to India. (Mejia, WHO 1975)


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Health Human ResourceS

200 hospitals have closed down within thepast two years no more doctors andnurses

800 hospitals have partially closed (with oneto two wards closed) lack of doctors andnurses

Nurse to patient ratios in provincial and

district hospitals now 1: 40 to 1: 60Loss of highly skilled nurses in all hospitals

across the country(Galvez-Tan, 2009)(Galvez-Tan, 2009)


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Health Education

The number of nursing schools

have increased

1970s: only 40

1990s: 170 June 2003: 251

April 2004: 370

June 2005: 441

June 2006: 470

Decreasing passing rate inthe national nursinglicensure examinations

1970s/80s: 80%-90%

1991: below 61%2001-2003: 44%-48%

2004: 55.9%

2005: 49.7%

2006: 41%

June 2008: 48%/35%

(PRC 2008)


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Health Services for Sale: Medical Tourism

Principally beingpromoted by thePhilippinegovernment usingthe public healthcare system

Linked to the issue of organ trade (i.e. saleof kidneys for

US$3,000-4,000)Expected revenues:US$ 10B in 5 years


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IGHT TO HEALTH OF THE PEOPLE


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ocial OBLIGATION ocial OBLIGATION .S .S PROFITROFIT

philippine situationer: global health course 2010

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