Behind universal health coverage: Social protection and the Philippines
As member of the Spanish All Party Group on Population, Development and Reproductive Health, I recently had the chance to participate in a parliamentarian field trip, supported by Action for Global Health, to a very special country: the Philippines. It is not only special for being a very populated state formed by 7,107 islands but for being at a crucial moment in the path towards being able to guarantee the right to health to its entire population.
This is a big challenge because of two main difficulties:
Poverty increases: although the Philippines has become a middle-income country recently, the percentage of poor people increases every year ( 26.5 percent of the population are classed as poor) and
The country is overpopulated, with more than 95 million people. That means a huge investment is needed for new public services to cover demand.
It is not an easy task for the President to promise Universal Health Coverage in a state where inequalities in society impact on everybody’s life. The richest 10 percent of people in the Philippines own 33.6 percent of national wealth while the 10 percent of the poorest have just 2.6 percent of wealth. The Aquino Heath Agenda aims to ensure nobody stays out of the health system by ensuring financial risk protection through expansion in enrollment of a National Health Insurance Program, a determined plan of improved facilities and the attainment of the health-related Millennium Development Goals (MDGs).
During our field trip, participants congratulated the Philippines’ government for such determination and for been able to scale up very quickly the number of enrolled citizens. However, we also showed our concern for the need to ensure sustainability by maintaining enough resources for health access. Inequity persists in many middle-income countries where the economy grows while the percentage of poor people remains the same. Reform of the tax system should be the basis of ensuring enough resources for universal health social protection, as well as other social services. It is the basis of reducing inequalities and promoting fairness.
The Philippines’ reforms include the strengthening of National Insurance by promoting the enrollment of middle classes while those poorest see their insurance paid directly by the Department of Health. I come from Spain, where until very recently everybody received the same level of care on a universal system where the whole budget came from one only financial source: general revenues. For us it is quite shocking to get to know more about health systems in some Latin American countries, where not everyone receives the same care, and where the right to health is based on your income and not on your needs.
The Philippines is an unusual case. There are different levels of care, but their pro-poor policy which means that even though the Ministry of Health pays for the poorest to get the best level of health care, poor and vulnerable people still don’t use the services as much as other citizens.
Something that only adds to this inequality problem within the health system is that the main decisions about services are taken at the local government level. The result is unequal coverage and quality of services in different parts of the country.
Therefore, we found three specific challenges: We must ensure sustainability, equity and fairness in the way the health services are funded; increase awareness of the right to health care among the poorest; and build a universal and public health system for the whole country. We are going to follow very closely not just in the Philippines but also the international development stage. If finally after 2015, and as some NGOs are demanding , Universal Health Coverage does become the new international commitment on health which will replace MDGs, it is essential to include in the future indicators of how to measure equity of care and funding, as well as ensuring an increasing number of poor people do demand and receive the health care they have a right to.