Universal health care debates
(Malaya Business Insight) - The fight for the reproductive health bill is far from finished. It is certain that discussions will continue not only on the controversial provisions opposed by the conservative Catholic hierarchy but also, perhaps even more importantly for poor Filipinos, on the broader topic of universal health care which is the stated theme of the present government’s health agenda.
The phrase “Universal Health Care” or UHC, a topic that has recently become a buzzword in health circles globally as health experts worry about the fact that large population groups in many countries, including the most powerful in the world, have inadequate access to good quality health care.
Here in the Philippines, we began serious discussions on this approach to health equity after the UP Centennial Lectures of 2008 revealed our health system’s sad record on equity. By the election of 2010, the idea of universal health care had been introduced into the political language of most of the presidential campaigns and later adopted as the health agenda of the eventual victor.
Unfortunately, much like the on-going debates on reproductive health, ideas, concepts, and issues concerning universal health care are poorly understood even within the health sector, let alone the public at large – especially those who will be most affected.
For this reason, a group of UHC advocates both within and outside the Department of Health have put together a UHC education and communication effort designed to stimulate public discourse on the issue of how to provide fair and equal access to high quality health services for all Filipinos who need them.
The effort is centered on a nation-wide series of formal student debates that are scheduled in the next seven months. For each of the next six months, monthly debates will focus on each of six components or “building blocks” of the Philippine health system that will require reforms towards the achievement of universal health care. These are: governance, health care financing, health information, health services delivery, regulation of health goods and supplies including medicines, and human resources for health. The last month will feature a synthesis of the discussions as inputs not only to national and local health programs but also to further discussions in the future.
Other forums in the form of focus group discussions, town hall meetings, round table discussions for officials and civic leaders, and other participative events have also been scheduled around the formal debates. Thus while the debates themselves will target school and youth audiences, the broader public will be engaged and encouraged to discuss all the issues and topics dealing with how health care can be more equitably accessed in this country.
For the month of August, the first debate topic is “governance” or how health systems operate or are managed. Governance is the component that determines how the other five components work to achieve desired results in health.
Health experts generally agree that because health systems, with their multiple players and stakeholders, complicated issues, increasing demands in the face of limited resources, are extremely complex so are the arrangements for their governance. There is less agreement on a definition that encompasses all activities and processes in health that can be considered as part of the governance component.
A common misconception is that governance is synonymous with government. Thus many discussions on health governance in the Philippine context focus on the roles of the national and local governments in the delivery of health services. This is why large chunks of the health system are left out in the formulation of policies, plans, and programs for health development.
The World Health Organization’s People at the Center of Health Initiative provided a useful framework for the analysis of health governance in 2004. The scheme identified four stakeholder “domains” that need to be involved in all aspects of the management of health development. The idea of using the term domains instead of levels is to avoid the implication that higher levels are more important than lower ones. These domains are: 1) policy and program planners; 2) health organizations, agencies, and institutions; 3) health providers; and 4) individuals, families and communities.
The top-down model of management that pervades the Philippine health system generally promotes the notion of a hierarchical relationship between these domains. The result is that the fourth domain (the individuals, families, and communities) is generally excluded from the decision-making processes on health issues.
If the country is to seriously address the issue of health inequity, the health sector must ensure that governance mechanisms include provisions to accommodate the first principle of good governance – namely legitimacy and voice, meaning participation by all concerned and consensus-based decision-making.