Duterte’s first SONA, one year later: Universal health care and the RPRH Law

By JESSICA BARTOLOME, GMA News, Jul 24, 2017

Every State of the Nation Address is both a look back and a look ahead—to the President’s accomplishments the previous year, and to what he or she plans to do next.

When President Rodrigo Duterte delivered his first SONA on July 25, 2016, he had only been in office for less than a month. However, many of the issues he talked about were already familiar to Filipinos as being close to his heart, thanks to the presidential campaign and his long tenure as Davao City mayor.

GMA News Online looks at some of the issues he discussed in his first SONA, and what the administration is doing to address them.

The Philippine Health Insurance Corporation (PhilHealth), the government corporation mandated to administer the National Health Insurance Program, is confident that universal health care is achievable.

In the Department of Health’s Philippine Health Agenda for 2016-2022, one of the guarantees is that PhilHealth will predominantly finance services, which will allow Filipinos financial freedom when it comes to accessing medical services. It stated that “100 percent of Filipinos are members.”

In an interview with GMA News Online, however, PhilHealth spokesman Dr. Israel Francis Pargas said that this has not yet been reached—the agency covers 91 to 92 percent of Filipinos as of 2016.

“That’s roughly around 93 billion Filipinos,” he said.

PhilHealth was provided a budget of P3 billion in the General Appropriations Act of 2017 to cover the remaining 8 to 9 percent of the population it does not yet cover, Pargas said. Should there be a shortage in the budget, the government will provide supplemental funds as needed.

“If a financially incapable patient is in the hospital or a health care facility who is not yet a member, that P3 billion will be utilized for him or her to get the PhilHealth benefits already…We will charge that benefit and reimburse that from the P3 billion,” Pargas said.

PhilHealth also recently approved the setting up of offices outside the Philippines to reach out to overseas Filipino workers (OFWs), including non-members.

It has also intensified membership campaigns and collection efforts.

Mentality, inconsistent incomes

Pargas said that Filipinos’ mentality towards PhilHealth poses a problem in implementing the universal health insurance system.

“Ang ilang mga kababayan natin hindi pa gaanong open sa idea regarding insurance. It’s not a priority still. Or they are just becoming aware once nangangailangan sila,” he said.

“Information, it will always be a challenge because we are talking to around 105 million Filipinos,” he added.

Another challenge is the inconsistent income of many Filipinos, preventing them from making regular contributions.

“The challenge would be informal economy…inconsistent income, the challenge on that would be the sustainability of their payment contribution and all,” Pargas said.

Pargas also admits that there are cases in which the insurance can’t cover unregulated medical costs and high out-of-pocket costs.

While PhilHealth has made efforts to make information available to the public, Pargas said they would need cooperation from everyone to achieve coverage for 100 percent of Filipinos.

“Hopefully by the end of the term of President Duterte we have already achieved the 100-percent coverage,” he said.

“Of course PhilHealth cannot do it alone, we need the help of everyone…to help us in making Filipinos understand the importance of having an insurance and maintaining the membership with PhilHealth.”

There are still gaps in the implementation of the RPRH Law—the biggest being the Supreme Court’s temporary restraining order on certain contraceptives.

But as early as the first quarter of 2017, several policies have already been implemented:

Executive Order No. 12, which aims to eliminate “unmet needs” for modern family planning;
an Administrative Order on guidelines for achieving desired family size, issued by Health Secretary Dr. Paulyn Jean Ubial in March 2017;
Department of Health Administrative Order 2017-0002, or the Guidelines on the Certification of Free Standing Family Planning Clinics; and
Department of Interior and Local Government Memorandum Circular 2017-85 on July 5, 2017, Guidelines in the Implementation of A.O. for Achieving Desired Family Size.

Chi Vallido, advocacy specialist of the non-government organization Forum for Family Planning and Development, said that these policies strengthen the mandate of local government units (LGUs) to implement the RPRH Law.

She also lauded the addition of the law’s implementation in the Duterte administration’s economic agenda.

“There were policies introduced by the government including the recognition of the full implementation of the RPRH Law as part of the economic agenda of the Duterte administration,” she said in an email to GMA News Online.

“On a scale of 1-10, I give this government a 7 when it comes to its support [for] the implementation of the RPRH Law,” she also said.

Need for Duterte’s ‘vocal’ support

Despite this, Vallido said that Duterte failed to vocally express his support for family planning and reproductive health, which would have greatly helped in pushing for improved services.

“I would have wanted the President to have vocally expressed his support to family planning and reproductive health and not just through written policies. His positive message, I believe would have emboldened people to demand for improved services,” she said.

“It would have also hastened the action related to addressing the TRO on Implanon and Implanon NXT that greatly affected the provision of FP services in the country,” she added.

In June 2015, the Supreme Court imposed a temporary restraining order on the procurement and distribution of hormonal contraceptive implants Implanon and Implanon NXT, and later expanded the TRO to cover other contraceptives.

The TRO has also prohibited the Food and Drug Administration (FDA) from issuing new certificates of product registration (CPR) for contraceptives.

Vallido said that already, certain FP brands are no longer available in the market, and the Philippines is in danger of losing majority of these brands. About 60 percent of products in the market will have expired certificates of registration by the end of 2017.

Information dissemination

There are other aspects of the RPRH Law that are overlooked. One of its provisions is about reproductive health care education and programs that will inform the public of their rights.

“That is another gap in the implementation. The government still does not have a massive information dissemination campaign to tell people about their rights and services under the RPRH law,” Vallido said.

The public still nurses a lot of misconceptions about various FP products. The biggest misconception, Vallido said, is that the RPRH Law is just about family planning.

She pointed out that there are 12 elements to reproductive health, not just family planning.

1. Family planning information and services which shall include as a first priority making women of reproductive age fully aware of their respective cycles to make them aware of when fertilization is highly probable, as well as highly improbable.

2. Maternal, infant and child health and nutrition, including breastfeeding

3. Proscription of abortion and management of abortion complications

4. Adolescent and youth reproductive health guidance and counseling

5. Prevention, treatment and management of reproductive tract infections (RTIs), HIV and AIDS and other sexually transmittable infections (STIs)

6. Elimination of violence against women and children and other forms of sexual and gender-based violence

7. Education and counseling on sexuality and reproductive health

8. Treatment of breast and reproductive tract cancers and other gynecological conditions and disorders

9. Male responsibility and involvement and men’s reproductive health

10. Prevention, treatment and management of infertility and sexual dysfunction

11. Reproductive health education for the adolescents; and

12. The mental health aspect of reproductive health care.

“People need to know these things so that they will be able to assert their right to services,” Vallido said.

Information dissemination will also combat another barrier impeding the implementation of the RPRH Law: anti-choice Catholic groups, who have been vocal in their opposition of the legislation.

“The RPRH law, particularly family planning services, will always be under threat by anti-choice Catholic groups. That is why we should raise awareness of people about medical and scientific evidences about the mechanism of action of various family planning products,” Vallido said.

Moving forward

The Family Health and Responsible Parenting line item in the law suffered from a huge budget cut in 2016, with its funds being reduced from P3.2 billion to P2.2 billion.

Then-Health Secretary Dr. Janette Garin said that the allocation for contraceptives had been stricken from the DOH’s 2016 budget, and that “the procurement of family planning commodities” has always been under threat of being removed.

But the department could do with bigger funds, Vallido said, which should be allocated for RH programs and family planning.

She urged Duterte to use his influence to support the law, and encourage allocating the necessary funds for the cause.

“The government need to seriously invest in RH programs and family planning through adequate budget,” she said.

“I still would want President Duterte to speak out in support of family planning and encourage the LGUs to put budget and improved programs and services for RH. His words are powerful and I would want to him to exert this power more in defending our reproductive health rights,” she added. — BM, GMA News