Real reforms needed to fight poverty (Fourth of five parts)

Editor’s note: The third part of this series discussed, among others, how various factors have affected the government’s programs to attain Millennium Development Goals.

According to the 2008 National Demographic and Health Survey (NDHS), a woman in the lowest wealth quintile will bear an average of 5.2 children in her lifetime, compared to an average of 1.9 children for a woman in the highest wealth quintile.

In general, this is because the poor have less access to more family planning methods, even though they may want to space or limit their childbearing.

For sure, proper medical attention and hygienic conditions during delivery are crucial in lowering the risks of women dying during childbirth. But in this area, there appears to be a huge divide between rich and poor women, between the educated and uneducated, and between urban and rural residents, according to the United Nations Population Fund (UNFPA).

In the National Capital Region (NCR), for instance, almost nine in 10 deliveries are attended by skilled health professionals, versus only two out of 10 in the Autonomous Region in Muslim Mindanao (ARMM), 2008 NDHS data show.

Indeed, the fact that she lives in Metro Manila may be why Claire Briones has yet to encounter any real problem while giving birth. Still, she says she dreads having any other medical emergency. At 35, Briones has four children; she is a single parent.

In theory, Briones’s family may qualify as one of the beneficiaries of the Conditional Cash Transfer (CCT) scheme that was the flagship anti-poverty program of the Arroyo administration and which is being continued by President Benigno Aquino 3rd.

Known previously as the 4Ps or the Pantawid Pamilyang Pilipino Program, the health component of the CCT program includes maternal health care for pregnant women, responsible parenthood seminars, and regular health check-ups and vaccinations for children below 5 years old.
But because the program is built on providing cash subsidies to indigent families, the question of sustainability has been raised against it.

Target: 4.7M families

For this year, the scheme’s target coverage is one million families. That translates to a monthly funding requirement of P500 million in health subsidies alone. President Aquino, however, plans to expand coverage to all poor families—a figure that reached 4.7 million at last count. CCT health subsidies would thus come to about P2.35 billion a month.

The specter of rising subsidies becomes all the more acute given the program’s apparent lack of any timeline (save for the maximum of five years that each beneficiary family can avail itself of the scheme’s benefits).

Local Government Secretary Jesse Robredo said that the CCT program had improved “health and education outcomes” in Naga City when he was mayor there. But he said that subsidies provided to the poor should be time-bound. “If not,” he added, “then [the program] is clearly not working.”

Briones does not seem to have heard of the CCT. But she said she was once a member of Philhealth, the national health insurance program that began in 1995.

President Aquino has promised Philhealth coverage for all Filipinos within three years. He may not have to do all that much to achieve that if one were to go by Philhealth’s claim of having 85 percent of the population as its members. Yet even assuming that Philhealth’s figure is accurate, ensuring universal access to health care is obviously more than handing out Philhealth cards.

Even current Philhealth members think twice before seeking treatment, considering that the insurance covers only a small portion of the fees in accredited facilities—about 20 percent to 35 percent, according to former Health Secretary Esperanza Cabral.

Leverage, ‘palakasan’

Briones said that even when she was still a Philhealth member, she would bring her children to the barangay health center instead of a Philhealth-affiliated facility. With the earnings of her tiny neighborhood sari-sari store barely enough to feed all her children and keep them clothed and clean,Briones simply has no budget for medical expenses. She said that she was able to use her Philhealth card just once, when she gave birth to her youngest child two years ago.

Briones was actually a beneficiary of Philhealth’s indigent program, in which a local government splits the premium payments with the national government. According to Philhealth’s 2010 first quarter report, the indigent program has 4.98 million beneficiaries, or about 25 percent of the entire Philhealth membership.

But even Cabral concedes that the program has been used for less than altruistic purposes. “Local government officials will actually use this as leverage for political favors, for votes, etcetera,” she said.

Briones herself said that she would not have gotten a Philhealth card had she not known the barangay coordinator assigned to her neighborhood. And now that the coordinator had passed away, Briones said she has been unable to renew her membership. She added that the new coordinator lives elsewhere and tends to favor her own neighbors.

“Palakasan kasi [It depends on who you know],” Briones said.

Last year, the National Economic and Development Authority (NEDA) also reported in its Updated Medium-Term Philippine Development Plan 2004-2010 that Philhealth’s sponsored program has been largely dependent on “the willingness of [local governments] to enroll their constituents.”

NEDA Social Development Staff Assistant Director Cleofe Pastrana said as well that in the past, many local governments were unable to sustain their part of the premium payments for Philhealth’s indigent program.

“That’s why the money at [the budget department] cannot move,” said Pastrana, “because without the [local government] counterpart, the money for health insurance wouldn’t be provided.”

The recalcitrance—and sometimes sheer unwillingness—of local governments to support national health programs or follow suggestions by the Health department has left the likes of Cabral exasperated.

Devolving health service

The way Cabral sees it, the most important reform that the health system needs is in the area of devolution. “We need to make up our minds whether the devolution of health services is good or not,” she said.

To which Robredo retorted: “It’s not a question of devolution, it’s getting the right people for [the task].”

He admitted, however, that local governments seem to be out of the loop regarding national health priorities. He cites the case of the Millenium Development Goals, among which the health-related ones focus on prevention.

“It’s not sexy at the local level,” said Robredo of the MDG thrust. “The issue there is ‘how many have I provided health assistance to.’”
But he argued that local governments would be encouraged to prioritize MDG-related programs if achieving the targets resulted in tangible rewards for the towns and cities, such as more funds.

Yet additional monies may not be enough to encourage local government executives to, say, allocate the necessary budget to keep their health centers stocked with contraceptives. That would, after all, mean, going head to head with religious leaders who wield great influence especially over rural communities.

Wanted: Direction

In 2004, then Health Secretary Manuel Dayrit issued Administrative Order 158 or the Contraceptive Reliance Strategy that gave local governments the task of providing contraceptives to their constituents—either for free or at cost.

The strategy’s failure can be seen in the lack of free contraceptives in public health facilities, which NEDA’s Pastrana said caused the very slow progress in contraceptive use rate. In 2003, the rate was 49 percent. Today the comparative figure is 51 percent—quite a long way still from the MDG target of 80 percent.

Some observers are optimistic that with the Aquino administration’s stance on reproductive health, local governments may give Administrative Order 158 a chance.

But there are those like Donato Macasaet, executive director of CODE NGO or the Caucus of Development NGO Networks, who said that they would be surprised if President Aquino would be able to achieve the health targets—particularly the one on maternal health—that the Arroyo administration had missed miserably.

Macasaet, though, said that he would be content if the Aquino government provides even just the direction so that the MDGs would be attained “if not in 2015, at least soon after.”

Bold blows vs. corruption, President Aquino’s winning the May 2010 polls triggered a contagion of hopefulness among Filipinos. He wooed and won votes with a slogan that was simple, yet catchy: ”Kung walang corrupt, walang mahirap,” or without corruption, there’d be no poverty.

The second Aquino presidency has spread a virus of hope that finds sole parallel in the tide of goodwill that Filipinos bestowed on his late mother and democracy icon Corazon “Cory” Aquino after the 1986 EDSA People Power revolt.

Indeed, President Aquino’s campaign equation of “no corruption = no poverty” has animated Filipinos so much that the expectations are great that he will deliver results soon.

But while his first two months in office marked vigorous efforts to address the first part—filing suit against alleged tax evaders nearly weekly, creating a
“Truth Commission” to hound crooks of the old regime, and firing midnight appointees of his predecessor, Rep. Gloria Arroyo of Pampanga—he has announced only tentative and inchoate initiatives to address the second part.

Thus far, President Aquino’s economic team has launched an “inclusive growth framework” for tackling poverty. It is a framework lifted—up to the level of many specific recommendations—from the World Bank Country Assistance Strategy for the Philippines titled “Fostering More Inclusive Growth,” which was released on August 19.

The concept was first enrolled in the Bank’s Country Assistance Strategy for 2010-2012 titled “Making Growth Work for the Poor” and dated April 2009.
And yet it was only on Monday, September 6, that Aquino issued a directive for the NEDA to formally start the crafting of the new Medium-Term Philippine Development Program (MTPDP) for 2011-2016. It is a document that should serve as his program of action but which officials said may take until yearend to finish.

On slow mode

It’s a slow-motion executive performance that has political and economic observers alike taking a second, hard look at President Aquino, who was a trailblazer in the last elections.

In fact, he is the first presidential candidate to beat a former president, Joseph Estrada, who until then held the record of securing the largest margin of victory in Philippine elections.

The country’s first bachelor president is also the first to be thrust to power via a national automated elections, the nation’s first. Those polls turned out to be the first fiercely contested in both old and online media as well; President Aquino won a crowded nine-candidate race in a balloting that saw a fourth “G” defining RP-style elections—gigabytes—aside from the guns, goons and gold of old.

By most accounts, however, President Aquino has remained true to his roots. It is in the image and likeness—and the same starting premises—of the mother’s presidency that the son has advanced to Malacañang.

Like Cory, President Aquino ran and won on the same franchise of integrity, or campaigning against both “material corruption” and “moral/spiritual corruption,” according to University of the Philippines political science professor Felipe “Pepe” Miranda.

This was captured in his campaign slogan. Yet, in reality, the catchphrase might be too simplistic.

Miranda, for one, does not think that by curbing corruption, a president could also automatically stomp out poverty, or that with corruption put in check, poverty will, on its own, work its way out of the system.

“The probability is that without corruption, you may not do away completely with poverty but you will do away with it, significantly,” Miranda said.

Lofty visions

The battery of economic technocrats in government knows this full well. The problem is that what they have spewed out so far seems to be long on lofty visions but short on concrete goals.

On August 18, at a midyear economic briefing, Socioeconomic Planning Secretary Cayetano Paderanga Jr., said: “The Aquino Administration aims to create adequate employment opportunities for many more Filipinos in order to significantly reduce poverty.”

Among the “strategies for inclusive growth,” Paderanga said the Aquino administration will launch the following programs: “better education, primary health care and nutrition, and other basic social services; equal access to infrastructure, credit, land, technology, and other productive inputs; improve governance and strengthen institutions to promote competition.”

In addition, he said: “we will equalize access to development opportunities across geographic areas and across different income and social spectra” and “among others, we will try to better education, primary health care and nutrition, and other basic social services.”

Finally, according to Paderanga, “we need to formulate and implement effective and responsive social safety nets to catch those who are left behind by the character of a high sustained growth.”

“Likewise,” he said, “in recognizing the devastating effects of climate change in the future, social safety nets that support and capacitate vulnerable sectors are necessary to address poverty.” –CHE DE LOS REYES PHILIPPINE CENTER FOR INVESTIGATIVE JOURNALISM

To be continued