Wednesday, June 20, 2007

Health system under siege

AN epidemic running amok in any of the country’s 19 regions will likely trigger a national calamity. The nation’s health system just can’t cope—we’ll just watch people die like flies.

Why, there’s less than one physician attending to every thousand populace. Two nurses have to tend to 1,000— a nurse for every 500 people. There’s less than one midwife seeing to every 2,000 people. Meanwhile, an 8,564-strong nationwide army of dentists can hack out separate niche clientele from a population over 80 million.

Here’s a calamity waiting to happen. More likely a doomsday scenario that has begun—a physician all by his lonesome self, wrenching his brains out to see to 1,000 disease-struck patients.

A deadly contagion has yet to strike. Who can tell when such a pestilence breaks out?
The vulnerability of the Filipino populace is palpable, as obscene as the splayed out legs of a whore on a payday night, open to all takers and every manner of assault.

Such pitiable figures on the state of the nation’s health system no longer hold—those are seven years old. Culled back in 2000, plied out in the 2007 WHO world health statistics as stark facts to look back in mourning. For all we care, current figures may likely point to a moribund state of the Philippine health system.

As the WHO compendium of facts and figures would have it, a nation’s health system isn’t about a network of hospitals, clinics, day-care centers, and similar infrastructures or facilities—a synergy of professionals make up a nation’s health system. Such a system consists of well-trained, competent and skilled people. WHO lists them as:


1. physicians,
2. nurses,
3. midwives,
4. public and environmental health workers,
5. community health workers,
6. laboratory health workers,
7. health management and support workers, and
8. other health workers.


The international standard for the ideal ratio of nurses to patients in hospitals is 1:4.
At the Philippine General Hospital, a nurse has to see to 15 up to 25 patients. In Davao del Sur and in most other hospitals, the nurse to patient ratio reaches from 1:50 up to 1:100. Over at the Don Susano Rodriguez Memorial Medical Center in Naga City, a nurse has to tend to more than 300 patients.

The patient overload means overextended working hours. The 40 hours work per week in a 100-bed hospital often stretches to 56 hours weekly. Doctors and nurses have to man their stations 16 hours straight whenever there is no reliever. No exemption for health workers assigned at the emergency room, laboratory and other stress-fraught departments.

And the pay isn’t that good.

The Nursing Law of 2002 mandates a P13,300 monthly paycheck for an entry-level nurse. Even so, violations have become trenchant: nurses in public hospitals receive at least P9,000, those in private hospitals get P4,000 a month. And there are nurses in the provinces who grub for as low as P2,000 monthly.

No wonder: PGH contributes 300-500 nurses/per year to the yearly outflow of 14,000 nurses going for overseas jobs. The nation’s tertiary school system can only turn up 6,500-7,000 nurses yearly. Even midwives won’t be left behind—they also seek greener pastures abroad as caregivers.

Available local supply doesn’t fill in the global demand yet: The United States needs around 10,000 nurses a year. Britain, Ireland, the Netherlands and other European countries need another 10,000 nurses yearly.

Filipino nurses have to hurdle the Commission of Graduates of Foreign Nursing Schools (CGFNS) and the National Council Licensure Examination (NCLEX) to work in the U.S. Passers get migrant visa status, which includes their spouse and children. Plus a work contract that pays US$4,000 a month. Some hospitals even offer subsidized housing grants. In the UK, only an English proficiency examination or TOEFL (Test of English as a Foreign Language) is required to obtain a work contract that pays about US$3,000 monthly.

A paper by former Department of Health Secretary Dr. Jaime Galvez-Tan points out that the Philippines is the second major exporter of physicians, next to India. Some 9,000 Filipino doctors have become nurses or are about to become nurses and nursing medics-- 1,500 have left the country, another 1,500 have just completed taking the nursing licensure examination. The 6,000 are enrolled in shortened one and a half to three-year nursing courses offered by nursing schools catering to the needs of doctors wanting to become nurses.

Four of every five public health physicians have taken up or are enrolled in nursing course with a view to leaving the country. Private sector doctors are unperturbed though as they earn the equivalent of $800 to $3,000 a month while services of "super specialists" like neurosurgeons and heart surgeons fetch about $18,000 for one operation.

Tan also cites that student enrolment in medical school has dropped by 14 percent a year beginning 2002. This has resulted in more medical schools closing shop—they lack students. The passing rate for physicians has also turned dismal from 86 percent in 1994 to 52.9 percent in 2004.

The WHO spreadsheet on the country’s seven-year old inventory of skilled professionals manning the Philippine health system can be an eye-opener for policymakers. WHO minimum for government spending on health is 5 percent of the national budget or gross domestic product—our government set aside 1.1 percent of its national budget on health in 2006. Vietnam spent 4.5 percent of its national budget on health in 2002; Thailand spent 7.6 percent last year.

WHO figures can also be construed by bio-terror purveyors as intelligence data that gauges a nation’s health defense capability: one physician has to tend to every thousand populace, two nurses tend to 1,000— a nurse for every 500 people. There’s less than one midwife seeing to every 2,000 people. That’s so pathetic a pool of health professionals stretched too thin, too near a breaking point.

An epidemic gone amok or a major bio-terrorist strike would leave such a health defense system in shambles—and an entire nation in disarray.

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