COVID-19 lesson 101: Winning pandemic wars through efficient primary health care
The pandemic is not over yet, and while everyone is in the thick of things working the way back to normalcy, much still need to be done to sustain the momentum towards recovery, keeping in mind the Covid-19 is most likely here to stay like any other existing diseases people contend with.
Despite the heavy blow it dealt with globally, the pandemic has taught lessons on preparedness of a nation or a community during health emergencies. It is also considered as a wakeup call for everyone to walk the talk about prioritizing the promotion of overall health care, and that the Covid-19 should be not the only disease that governments must focus on but also the illnesses that have been silently claiming thousands of lives every year due to lack of immunity and early interventions.
The pandemic has also served as “lesson 101” that should remind us of the importance of primary health care in surviving health emergencies – where everybody understands that having access to primary health care is a basic right, that every place where there is a human regardless of social status should have access to a functional health facility and capable health workers, where sufficient resources are poured to assure everybody gets treated when in need, and where no one is left behind helpless when they fall ill.
The Philippine government, even before the pandemic hit in 2020, passed a landmark piece of legislation, Republic Act 11223 or the Universal Healthcare (UHC) Act in 2018, which puts primary healthcare on center stage through reforms that aim to improve its health care systems from national to the grassroots levels.
By putting primary health care and essential public health functions at the core of integrated health services, empowering people and communities, and having actively involved and supportive local government units, the UHC law aims to achieve responsive and resilient health systems where communities know when and how to seek for health services that are available when needed, and in case of emergencies, are well-equipped to face and survive other pandemics should it occur in the future.
Tough road ahead for UHC
But the challenges are tough and cannot be addressed overnight.
In the Cordillera, a region consisting of hard-to-reach localities referred to as geographically isolated and disadvantaged areas (GIDAs), the Department of Health explained to the Baguio Midland Courier it is facing an uphill battle in fully implementing the UHC Law, but has assured it is now in the process of preparing for the law’s full-blast implementation by identifying the challenges on the ground up and coming up with solutions suitable to each of the region’s six provinces and one city.
The DOH-Cordillera is also partnering with the LGUs and political leaders, who may have realized the importance of basic health care services and interventions such as vaccination efforts in their Covid-19 experience, to help LGUs function sustainably and stand on their own in protecting the health of the populations.
Private sector partnership, such as those involved in sustaining the advocacy for the full implementation of the UHC law and helping improve the overall health of Filipinos through good promotion and disease prevention, including the expansion of vaccine coverage under the UHC program, is also crucial in attaining healthy communities and dealing with what the Philippine NGO Council on Population, Health, and Welfare, Inc. (PNGOC) calls “existing but silent pandemics” other than the Covid-19.
Piloting UHC in CAR
DOH-Cordillera Director Rio Magpantay said while health is a basic right, many individuals not only in the Cordillera but also in other regions have not yet fully grasped its meaning and importance based on their data.
This, he said, is the reason the government worked on finding what has to be done so that people would get the health services they need. This gave birth to what is now collectively called the UHC, which became mandatory when it was made into law under the Duterte administration.
The question is whether health services in the first place can be accessed by all, especially the poor and those who are located in difficult to reach areas.
“Ang layunin ng UHC ay dapat walang maiiwan lalung-lalo na ang mga mahihirap. Pero paano ba gagawin ito, especially in our area, the Cordillera, kung saan marami tayong GIDA. Doon ba sa malalayong lugar, nakakarating ba ang serbisyong pangkalusugan?” Magpantay said.
He said the UHC aims to reach every corner in line with the agency’s vision of “saan mang sulok, kalusugan ay maaabot sa Cordillera.”
Fortunately, the Cordillera is one of the regions in the country chosen as pilot sites for the full implementation of UHC this year based on the provisions of the law.
As a first step, Magpantay said they need to convince LGUs to be involved since they are expected to be fully capable eventually on providing primary health care with DOH’s support and guidance.
“It is important for the political leaders to be part of this because it means we will be able to formulate strategies to achieve the goals of UHC. It will be difficult to attain our goals if local governments are not willing to be involved because as we know health as a basic government service has been devolved to our LGUs,” Magpantay said.
Second, the DOH is currently working on assessing the maturity level of local health systems in the region, which has to be done to determine if these are functional or able to reach the functional level to implement the UHC based on certain criteria.
Magpantay said this is part of the assessment because there is a need to determine the readiness of LGUs to handle and ma-nage the Special Health Funds to be provided to LGUs under the UHC law to be used for the needed or suitable health services in the different provinces.
“Provinces or its respective local health systems (up to the barangay level) may have different maturity levels, because we cannot say provinces have the same situations. They deal with different diseases. They have different health issues, so strategies will also vary to achieve good health for everyone,” Magpantay said.
Reducing LGU dependence on nat’l govt
In a nutshell, reforms being championed under the UHC law include reducing the dependence of LGUs on national government in terms of caring for the health of their constituents by helping them stand on their own.
Candidly, Magpantay said the Cordillera and the whole country for that matter are not ready yet to manage on its own, particularly on health personnel, equipment, and infrastructure.
He said the DOH currently helps LGUs by providing them technical assistance like personnel training, manpower, establishment of health facilities, and logistics based on the need of localities.
“But until when? What we want to attain is for LGUs to be independent and be given enough resources based on their funds and identified strategies, so that DOH will be there only for guidance. But the country is not yet ready, so DOH will continue helping by providing funds where it is needed,” Magpantay said.
Since most LGUs cannot afford it yet, he said DOH still provides funds for development of health facilities like barangay health stations in hiring nurses and midwives and other allied health professionals, and training of personnel.
“Pero hindi naman kami magsasawa hanggang kaya ng DOH. Ang minimit-hi lang namin ay ang mga LGU very soon tumayo sila sa sarili nilang paa. Meron naman, dahil devolved ang functions, they can stand on their own since ang pondo na nilalaan sa kalusugan ay mas malaki na. Ngunit minsan nakikiusap pa kami na maglaan sila ng a little more percent of their fund para lang maisakatuparan ang mga health-related activities,” Magpantay said.
Relearning the basics
Despite the grave threats posed by the Covid-19, Magpantay said it is sad there is still a lot of room for improvement in the health-seeking behavior of most people and their willingness to immunize themselves from vaccine-preventable diseases.
He said a lot as well has to be done to increase public awareness on primary health care, particularly the healthcare provider network, and even on the knowledge of health workers themselves about UHC.
“That exactly is what we are focusing on. Does everyone already know where to go when they get sick? Do they go directly to the hospital or to a rural health unit? Do they know there is a barangay station? Maybe they have knowledge, but not that much. Kaya ito rin ang dapat pagtuunan ng pansin sa DOH, pero hindi lang dapat kami, pati iba sanang stakeholders would help in raising awareness on what to do and making sure health services are accessible when patients need them,” he said.
On the part of healthcare providers in RHUs, Magpantay said they should know where to refer patients needing higher level of care. “We are currently looking into this and developing the proper strategy.”
For this, the DOH-Cordillera is currently conducting training on patient navigation and referral system in line with the region also being a pilot site in the formulation of suitable referral systems and is expected to come up with a manual that health providers in the Cordillera and other regions may use.
The DOH-Cordillera is also focusing on its Health Promotions Unit and Communications Management Unit, which will check and make an assessment on the health seeking behavior of individuals and help increase their literacy and understanding of primary health care.
“I can say hindi pa ganoon kalaki ang nagagawa ng DOH para dito, kaya ngayon pinagtutuunan namin ng pansin na kailangan maintindihan ng bawat isang mamamayan, pati na ang mga mismong health care workers, ang importance ng health at ng UHC,” Magpantay said.
Learning from Covid-19 and primary health care
“The Covid-19 pandemic had a great effect in people’s lives, in the political system, as well as to the way different government line agencies work. Talagang naiba ang mindset natin because we saw through the pandemic how ready the country was for pandemics that may happen,” Magpantay said.
Lack of preparation was especially observed among the LGUs, although the same is true in most countries.
“Nakita natin na talagang wala tayong pagha-handa. What happened was the national government took action and LGUs became dependent on its guidelines. Now, with the UHC law and if local government are ready with measures they could adopt in case there’s another pandemic, then makakaya nila, because eventually LGUs will be equipped to take action,” Magpantay said, adding if political leaders and LGU officials are involved, then things that need to be done will be realized to achieve the goal of UHC of ensuring primary health care services are felt on the ground that will equip communities in the event pandemics like the Covid-19 again occur.
“On the other hand, parang nagdulot ng maganda ang pagkakaroon ng Covid-19 pandemic sa kahandaan ng ating bansa kasi natuto tayo. Once the Special Health Funds are provided to LGUs, they may use it in their disease prevention activities and pandemic response, especially in terms of epidemiology and surveillance whose role had been crucial du-ring the Covid-19 pande-mic.
If every LGU has a functional epidemiology and surveillance, then they will be capable of responding efficiently when cases of diseases rise to emergency levels,” he said.
Expanding vaccine coverage under the UHC Program
The PNGOC, a national network of NGOs that work with national and local governments in promoting health and well-being of Filipinos toward a humane and just society, shared other learnings from the Covid-19 that led to its advocacy for the expansion of vaccine coverage under the UHC.
Chi Laigo Vallido, PNGOC executive director, said while Covid-19 has killed over 66,000 Filipinos, two vaccine-preventable diseases have claimed thousands of Filipinos also in alarming magnitudes – influenza kills 5,300 or 1.11 percent of Filipinos each year and over 40,000 died due to pneumonia in 2019, with two-thirds of these deaths occur among those over 60 years old.
She also pointed out: According to the Unicef, the Philippines ranks fifth in the world and third in Asia for zero-dose children, with one million unprotected children for diseases like diphtheria-pertussis-tetanus and measles.
The 2018 Longitudinal Study on Ageing found that 30 percent of older people said that they felt ill in the preceding 12 months and thought of going to the doctor but did not and 20 percent of elder Filipinos cannot afford medical treatment.
A study of the University of the Philippines Population Institute showed only three out 10 older people are aware of flu vaccines and only four out of 10 are aware of pneumococcal vaccines.
It found only about 19 percent of Filipinos 60 years old and above are aware of flu and pneumococcal vaccines but are vaccinated for either of them. This group is characterized as belonging to the older age groups, males, rural residents, poor, and less educated, according to the study.
In 2021, the DOH found that 47 percent of older people fear Covid-19 vaccines despite 72 percent believing they are necessary for their health.
“We are moving outside of Covid-19 and we need to prepare for the next pandemic. There is already an existing silent pandemic that is not really being discussed but it needs to be funded because it’s vaccine preventable and older people are at risk,” Vallido said.
She said we don’t have to wait for the next pandemic to prepare but right now awareness on the importance of vaccination being a primary health care must increase.
Vallido said in discussing improvement of health, the approach should be holistic or should cover a person’s life cycle, which means addressing all diseases, including males and females, and from birth to old age should be funded since the burden of expenses when one gets sick is catastrophic even with PhilHealth coverage.
“Talagang catastrophic sa pamilya kapag nagkasakit tayo, ibig sabihin naghihirap tayo, nawawalan tayo ng pera. So we should think on investing on health programs which address diseases that we could anticipate,” Vallido said.
Administration of vaccines against applicable diseases should also be throughout the life cycle and this should be integrated in health programs.
Baguio as pilot city for improved health system via UHC
This year, PNGOC is piloting in Baguio City along with two other areas in the country the Rockefeller Foundation-funded Sikat project or Sama-samang Inisyatiba para sa Kalusugan ng Taong Bayan sa Universal Health Care, which aims to contribute to reducing data gaps on primary health indicators by coming up with baseline data on the pilot areas’ health situation to support the local government and the DOH UHC program to improve health seeking behavior and address stigma and treatment hesitancy.
Vallido said the project also aims to increase community awareness about DOH and LGU health programs and services; build capacities of civil society organization partners, local leaders, and health workers to better address misinformation that result in treatment hesitancy; and help strengthen the referral pathways and service delivery networks among barangays, barangay health stations, and other stakeholders working on primary health care service.
In a meeting in March, PNGOC and Mayor Benjamin Magalong and City Health Services Officer Celia Flor Brillantes discussed the Sikat project’s pilot implementation in the city to study and understand its local health response at the barangay level which will allow the partnership to advocate improvements through the UHC.
Vallido said if the project succeeds in the pilot areas, they could use the strategies as a model in making vaccine coverage as a routine in the life cycle for improved health.
“Kailangan ganon na ang mindset ng mga Pilipino kasi bumabalik ang ibang diseases and the burden of having diseases is great. Mataas ang cases natin for some diseases like HIV and tuberculosis. Napag-iwanan na tayo talaga when it comes to health at aminado naman ang DOH,” Vallido said.
Aside from the need for life cycle approach to health, she echoed the DOH’s belief about using the lessons from the Covid-19 pandemic in improving local health systems preparing for the next pandemic.
“After we finish the baseline of health situation in Baguio, we will get to see, understand, and address underlying causes of other health concerns in the area such as when there are cases of malnutrition or other discoveries, so that it can be prioritized and work with the LGU and DOH to address the gaps and improve health services,” Vallido said.
She added the measure how the government cares for its citizens is through health support, more than roads and infrastructures, but without undermining the latter’s importance. “For us, health talaga ang top measure of care, on how the government values its citizens.”