This paper presents a brief analysis of the current situation of Philippine health institutions using secondary data. It locates the different types of health institutions, describes its major problems, discusses recent approaches these institutions have adopted to improve delivery of health care services and extricates policy-related issues and data gaps from available literature.health sector, hospitals, hospital care, health centers

Chiong-Javier, Maria Elena

Ramos-Jimenez, Pilar

English

Research Papers in Economics

Notes
JournalofPhilippine Development NumberTwenty-Seven, VolumeXV, No.2, 1988 Ill
THE PHILIPPINE HEALTH INSTITUTIONS: SOME PROBLEMS,
APPROACHES AND POLICY ISSUES
Pilar Ramos-Jlmenez
Ma. Elena Chiong-Javier
Introduction
Healthinstitutions, typifiedby hospitals,barangayhealth stationsor health
centers,and rural healthunits,continueto carrythe majorburdenof providing
healthcare servicesto the majorityof the Filipinopopulation. Like othertypes
of socialinstitutions in the countrytoday,they are also badlyaffectedby a host
of formidableeconomicproblemssuchas inflation,prohibitiveinterestrateson
borrowedcapital,and dwindlingcapitalreservesWhichhave been compounded
by recent politicalupheavals. In the case of privatehospitalsalone, a survey
doneby the PhilippineHospitalAssociationduringthe lasttwoyears showsthat
over 70 hospitalshad eitherdeclaredbankruptcy,had folded up,or were in the
processof beingforeclosedbytheircreditors(Clemente 1986). The situationin
the governmentsector is equally, if not even more pathetic. It is publicly
acknowledgedthatgovernmenthospitalsand healthstationshave been operat-
ingwithinadequatefunds,therebyaffectingboththequantityand qualityof their
healthservice deliverysystem.
This paper presentsa brief analysisof the current situation of health
institutionsin the countryusingsecondarydata. Specifically,it aims to: (1)
locate the differenttypes of health institutions; (2) describe major problems
encounteredbythe healthinstitutions;(3) discussrecent approacheswhichthe
healthinstitutions have evolvedto improvetheirdeliveryof healthcare services;
and (4) extricatepolicy-relatedissuesand data gaps from available literature.
Distribution of Health Institutions
Hospitals. At present, the Philippineshas a total of 1,821 licensed
hospitals. Of this figure,aboutone-thirdare governmentinstitutionswhilethe
The authorsare Associate and Assistant Professors, respectively, Behavioral
Sciences Department, De La SalleUniversity, Manila.
Thispaperis partof thepaperspresented during thePIDS-UPSEseminar on "A
Program of Research on HealthPolicy and Development" onDecember17-18,1986.282 JOURNAL OFPHILIPPINE DEVELOPMENT
to implementa hospitaldevelopmentprogramfor each ofthe district
hospitalsin order that these may achieve a progressivelevel of
healthcare (i.e., from a primarytype to secondaryand from secon-
dary to tertiary) that will adequately satisfythe communityhealth
needs;and c) to establishan inter-referralsystemamonggovern-
menthospitalsas well as betweengovernmentand private hospitals
for the promotionof betterqualityof healthcare withinthe region.
Atpresent,the programincludes11 governmenthospitals,sixof whichare
operatedbythe city or municipalityandfive bythe nationalgovernment. Some
of itsaccomplishments arethe following:twomunicipalities have been subsidiz-
ingbeds and servicesin privatehospitals;one citydistrictis being served by a
Collaborating privatehospital;and five new hospitalsare to be constructedby
their municipalgovernmentswith the assistanceof the MMC. Districthospitals
have substantiallyimprovedtheir servicecapabilitiesand are on their way to
handling higher types of medical care. For example, general hospitalsof
Caloocan, Pasay, Valenzuela, and ParaSaquewere upgradedfrom S-L-U or
sipon-lagnat-ubo primary centers to A-C-H or appendectomy.caesarian-heart
secondary hospitals;others like Tondo General, Hospitalng Maynila, Quirino
Memorial,and QuezonCity General Hospitalare fastdevelopingfromsecondary
to tertiary level of healthcare.
Most significantly, inter-hospital relationships have resultedin the sharing
of resourcesbetween the governmentand privatesector. This has led to the
formationof a loose inter-referralsystemwith larger medical centers admitting
patientsfrom governmenthospitalsfor diagnosticand sophisticated therapeutic
services. The latterhas respondedbytaking withintheirservice those patients
who cannot afford the hospitalizationcosts in the private institutions. Their
partnershiphas also been extended to manpower training, with the private
institutionssharingtheir wealth in training materialsand technical knowhow.
Governmenthospitalsand medical/nursing schoolsand their traininghospitals
have both benefited from their linkages, e.g., when the former's residency
programsadmit exchangeof fellowships with the latter. Andlastly,service and
trainingare notthe onlyitems shared;there is also sharingof equipment(such
as oxygentanks, anaesthesia machines) and even suppliesin the spirit of
neighborliness.
In Iloilo,Ardena (1986) has also foundparalleladvantagesin the consor-
tium by and betweenthe IloiloDoctors'Hospital(private)and the IloiloProvincial
Hospital(government)whichhe leads. Thisformal network,whiledifficultat the
start, has attained for both hospitals,significantimprovementsespecially in
medical education program because of combined manpower utilizationand
equipment- or sharingof facilities.
Primary health care (PHC). This approach has recently emerged as a
promisingresponse to the dismal healthsituation, especiallyamongthe poorRAMOS-JIMENEZ andCHIONG-JAVIER: HEALTH INSTITUTIONS 283
majority, IthasbeendescribedbyDr.S.T. Hanof the WorldHealthOrganization
(WHO) as a practical means for "making essential health care universally
accessibleto individualsand families in a communityin an acceptable and
affordableway and with their full participation" (cited in Salceda 1986). In
essence,the approachrequireshealthto be viewed in itstotality (i.e., disease
istheeffectofbothbiological,socioeconomic andotherfactors). It alsorequires
bothhealthproviders and userstobecomeactive partnersinthe treatmentof the
foundationsof ill health.
The PHC issaidto havestartedinthe late 1960s,even beforethe historic
1978 Alma Ata Declaration. Private practitionersfrom hospitalsand clinics,
healthorganizationsand academicinstitutionsinsomeparts of the countrywere
thepioneersofthismethod(Galvez-Tan1986). Itwas, however,onlyinthe mid-
seventies, when the Rural Missionariesof the Philippinesbegan their pilot
community-basedhealthprograms(CBHP) in threeparts of the countrywiththe
CatholicChurchNetworkas the conduit,that a nationwidePHC movementwas
felt. Their experiences were later adopted by the Protestantsthrough the
National Council of Churches and the AKAP, a secular organization. Both
institutionsestablishedtheirown nationwidenetworks. At present,the CBHPs
are found in 40 provinceswith some 200 health personneland about 3,000
community health workervolunteers(Galvez-Tan 1986).
It was only in 1981 when the governmentimplementedthe PHC on a
nationwidescale. By 1985, the Ministryof Health(MOH) reportedthatthe PHC
is operatingin all barangaysexceptin a few areas wherethe peace and order
situationisunstable. The implementationof thisapproachlargelyrestedon the
involvementof community members in the delivery of health care services.
Thus, residentvolunteerhealthworkershavebeen trainedbygovernmenthealth
agencies to do health extension work in their respectivecommunities. For
example,todate, a totalof 365,941 barangayhealthworkers (BHWs)havebeen
mobilized(with a ratio of one BHW to 20 households)and 14,718 Boticas sa
Barangay have been established,with almostthe same numberof pharmacy
aides to runthese community pharmacies(Galvez-Tan 1986).
Policy and Research Issues
The review of literature has raised policy and/or research issueswhich
includethe following:
1. Intersectorallinkages. The experiencesgeneratedby horizontal (i.e.,
between hospitals)and vertical(i.e., between hospitalsand health
stations/RHUs)linkagesamonghealthinstitutions have proventobe
beneficialto these institutionsas well as to theirclients. In these
timesof economicdifficulties,it is imperativethatsuch linkagesare
ctrengthened,enhanced,andfurtherinstitutionalized.To dothis,the
experiencesof cooperatinginstitutionsneed to be documentedand284 JOURNAL OF PHILIPPINE DEVELOPMENT
analyzed to draw lessons for the improvementof the linkages.
There isalso a need to understandthe impactof sharingarrange-
ments on the overall health situationin areas where they are
undertaken. Moreover,consideringthe pervasive influenceof pri-
marytypesof institutions on people'shealth,itmay be worthwhileto
cultivatethe verticallinkages.
2. Communityparticipation in health care de/ivety. Given the existing
constraintsin resources,there is littledoubt on the necessity of
tappingsectorsotherthan those traditionally connected with health
institutions. The inclusionof communityvolunteerworkers in the
healthservicedelivery systemthroughthe PHC programseems to
be a promisingstrategy. .However, recent experiences with the
government's PHC program have exposed certain difficulties in
sustaining communityinvolvement becauseof poorfinances,central-
izeddecisionmaking processes,inadequateskillsand proliferation of
differenttypesof barangay healthworkersconnected with govern-
mentlineagencies. There is a needto explorethe extentto which
thesedifficulties pervadeandhamperthe achievementof PHC goals
in the countryin view of the growing acceptanceof the people's
participationamong governmenthealth agencies and institutions.
There is also a need to comparethe experiencesbetween govern-
mentand privatesectorsemployingthisconcept,as well as among
government health institutions,to derive better mechanisms for
implementation.More importantly,there isa needto reviewnational
healthpoliciesinorderto determineto whatextentthey are congru-
ent and supportiveof communityparticipationin healthcare.RAMOS.JIMENEZ andCHIONG-JAVIER: HEALTH INSTITUTIONS 286
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