Health Health Promotion and Promotion and

Integrative Integrative Health Care Sub-Health Care Sub-cluster Proposal cluster Proposal

for FY 2014for FY 2014

Alternative Budget Initiative (ABI) Health Cluster

Health Promotion and Health Promotion and Integrative Health Care Integrative Health Care

Sub-cluster Sub-cluster Health promotion is the Health promotion is the

process of enabling people process of enabling people to increase control over to increase control over

their health and its their health and its determinants, and thereby determinants, and thereby

improve their healthimprove their healthOttawa Charter

1986

Health Promotion and Health Promotion and Integrative Health Care Integrative Health Care

Sub-cluster Sub-cluster Integrative Health Care is Integrative Health Care is

awareness, a consciousness of awareness, a consciousness of viewing health as a state of viewing health as a state of total well-being resulting from total well-being resulting from the interplay of socio-economic, the interplay of socio-economic, political and spiritual aspects of political and spiritual aspects of life. Basic to this consciousness life. Basic to this consciousness is the understanding that is the understanding that health is a fundamental human health is a fundamental human right and responsibility of the right and responsibility of the individual and, collectively, of individual and, collectively, of the community.the community.

This PIM consciousness adheres to the This PIM consciousness adheres to the integration of different systems of medicine integration of different systems of medicine based on empirical and scientific knowledge, based on empirical and scientific knowledge, rooted in the culture of the people. Such an rooted in the culture of the people. Such an integrated system addresses the health integrated system addresses the health problems in the community through promotive, problems in the community through promotive, preventive, curative and rehabilitative services, preventive, curative and rehabilitative services, which are accessible, affordable, available, which are accessible, affordable, available, effective and acceptable to the people.effective and acceptable to the people.

PIM, as an evolving consciousness, emphasizes PIM, as an evolving consciousness, emphasizes the direct, responsible and sustained the direct, responsible and sustained participation of people in the development of participation of people in the development of their alternative health care systems, an their alternative health care systems, an indicator of the fulfillment of their aspiration for indicator of the fulfillment of their aspiration for self-determination.self-determination.

Uses primary healthcare approach as a strategy Uses primary healthcare approach as a strategy (Alma-Ata Declaration) (Alma-Ata Declaration)

Influenced by INAM…Influenced by INAM…

Primary Healthcare Primary Healthcare ApproachApproach

Essential health care based on practical, Essential health care based on practical, scientifically sound and socially acceptable scientifically sound and socially acceptable methods and technology made universally methods and technology made universally accessible to individuals and families in the accessible to individuals and families in the community through their full participation community through their full participation and at a cost that the community and and at a cost that the community and country can afford to maintain at every country can afford to maintain at every stage of their development in the spirit of stage of their development in the spirit of self-reliance and self-determination. – self-reliance and self-determination. – Alma-ata DeclarationAlma-ata Declaration

Primary care and Primary care and Primary HealthcarePrimary Healthcare

Primary Care, the shorter term, describes a Primary Care, the shorter term, describes a narrower concept of "family doctor-type" narrower concept of "family doctor-type" services delivered to individuals. Primary services delivered to individuals. Primary Health Care is a broader term which Health Care is a broader term which derives from core principles articulated by derives from core principles articulated by the World Health Organization and which the World Health Organization and which describes an approach to health policy and describes an approach to health policy and service provision that includes both service provision that includes both services delivered to individuals (Primary services delivered to individuals (Primary Care services) and population-level "public Care services) and population-level "public health-type" functions.health-type" functions.

http://www.ncbi.nlm.nih.gov/pubmed/17120883

SITUATIONER/CONDITIONSITUATIONER/CONDITION

We are in a situation where the Philippine We are in a situation where the Philippine government’s policy including its budget government’s policy including its budget is greatly skewed towards the curative is greatly skewed towards the curative and conventional approaches of medicine and conventional approaches of medicine and it has been happening for years now.and it has been happening for years now. More budget towards More budget towards

infrastructure/hospital/medicine-based kinds of infrastructure/hospital/medicine-based kinds of good and servicesgood and services

No clear support for the traditional and alternative No clear support for the traditional and alternative healthcare healthcare

Let’s review the current government’s Let’s review the current government’s policies on health…policies on health…

Healthy population

Population at risk

Population with sickness

Sick that need hospitalization

but have no access to

hospital care

Sick and

hospitalized

Percentage of DOH Percentage of DOH Budget Support for NCD’s Budget Support for NCD’s

and NCHP and NCHP YEAR

NON-COM

%(fr DOH budget)

TOTALNCDPC

%(NON

COM fr NCDPC budget)

TOTALNCHP

%(fr DOH budget

TOTAL DOH

2014 (Propose

d)

677,891,000

0.85%7,542,42

3,0008.99%

165,227,000

0.21%80,171,300,000

201370,764,0

000.14%

6,736,124,000

1.05%162,479,

0000.32%

50,442, 299,000

201268,766,0

000.16%

6,267,343,000

1.10%153,230,

0000.36%

42,155,963,000

201135,849,0

000.11%

5,342,956,000

0.67%153,978,

0000.48%

31,828,616,000

201035,849,0

000.14%

4,779,139,000

0.75%172,322,

0000.70%

24,649,765,000

200926,377,0

000.11%

4,509,107,000

0.58%167,200,

0000.71%

23,666,655,000

Budget of the NCHPBudget of the NCHP

Year PS MOOE CO Total2011 14,618,000 139,360,000 153,978,000

2012 13,870,000 139,360,000 153,230,000

2013 17,952,000 144,527,000 162,249,000

2014(NEP)

16,794,000 148,433,000 165,227,000

AQUINO HEALTH AGENDA AQUINO HEALTH AGENDA (AHA)(AHA)

The Universal Healthcare under Aquino AdminThe Universal Healthcare under Aquino Admin

Primary Health CarePrimary Health Care

Health Sector ReformHealth Sector Reform

Integrated Referral SystemIntegrated Referral System

National Health Insurance National Health Insurance Program (PhilHealth)Program (PhilHealth)

UHC for government is…UHC for government is…

Not a one-size-fits-all concept nor does Not a one-size-fits-all concept nor does coverage for all people necessarily coverage for all people necessarily mean coverage for everything.mean coverage for everything.

Maintain coverage in three critical Maintain coverage in three critical areas: who is covered from pooled areas: who is covered from pooled funds, what services are covered, and funds, what services are covered, and how much of the cost is covered. how much of the cost is covered. Within this broad framework, we, the Within this broad framework, we, the policy makers, will have to decide how policy makers, will have to decide how and how much of the funds have to be and how much of the funds have to be raised and administered.raised and administered.

UHC for government UHC for government is…is…

Improving the implementation of the National Improving the implementation of the National Health Insurance Program by means of reforms in Health Insurance Program by means of reforms in PhilHealth’s operationsPhilHealth’s operations

Includes the enhancement of information Includes the enhancement of information dissemination activities, streamlining processes to dissemination activities, streamlining processes to facilitate enrollment and other transactions for facilitate enrollment and other transactions for members, and mobilizing our burgeoning reserves members, and mobilizing our burgeoning reserves to reduce out of pocket expenditures of its to reduce out of pocket expenditures of its members which may range from 60-90% of total members which may range from 60-90% of total hospital costs, depending on the disease incurred.hospital costs, depending on the disease incurred.

Furthermore UHC Furthermore UHC means…means…

Enhancing government health Enhancing government health facilities such as hospitals, rural facilities such as hospitals, rural health units, health centers, health units, health centers, and placing able health workers and placing able health workers to operate these facilities, and to operate these facilities, and stocking them with quality and stocking them with quality and affordable medicinesaffordable medicines

StrategiesStrategies

Public-private partnership to expand, Public-private partnership to expand, upgrade, and modernize our 25 major upgrade, and modernize our 25 major medical centers to the tune of several medical centers to the tune of several billion pesosbillion pesos United Nations European Commission for Europe United Nations European Commission for Europe

(UNECE) through its International PPP Center of (UNECE) through its International PPP Center of Excellence just recently selected the Philippines Excellence just recently selected the Philippines to be the Specialist Center for PPP in Healthto be the Specialist Center for PPP in Health

Work closely with the other national Work closely with the other national government agencies, local governments, government agencies, local governments, civil society and foreign development civil society and foreign development organization and the private sectororganization and the private sector

The three strategic The three strategic thrusts:thrusts:

Financial Risk Protection through Financial Risk Protection through expansion in National Health expansion in National Health Insurance Program enrollment and Insurance Program enrollment and benefit deliverybenefit delivery

Improved access to modern Improved access to modern hospitals and health facilities hospitals and health facilities

Attainment of health related MDGs Attainment of health related MDGs

Investing in Kalusugan Investing in Kalusugan Pangkalahatan Pangkalahatan

pursuant to the Social Contract provisionspursuant to the Social Contract provisions

Investing in our people, reducing Investing in our people, reducing poverty and building national poverty and building national competitivenesscompetitiveness

Advancing and protecting public Advancing and protecting public healthhealth

Building of capacities and creation Building of capacities and creation of opportunities among the poorof opportunities among the poor

Increasing social protectionIncreasing social protection

ISSUES AND ISSUES AND CHALLENGESCHALLENGES

People as patients ONLY not as partners in People as patients ONLY not as partners in developing and implementing healthcare developing and implementing healthcare

Infrastructure and doctor-based; Skewed Infrastructure and doctor-based; Skewed primarily to curative care rather than primarily to curative care rather than prevention prevention

Universal Healthcare equals universal coverageUniversal Healthcare equals universal coverage

It does not extend to the underlying It does not extend to the underlying determinants of health: food and nutrition, determinants of health: food and nutrition, housing, access to safe & potable water & housing, access to safe & potable water & adequate sanitation, safe & healthy working adequate sanitation, safe & healthy working conditions, healthy environment, education & conditions, healthy environment, education & participation. participation.

ISSUES AND ISSUES AND CHALLENGESCHALLENGES

Devolution of our Healthcare SystemDevolution of our Healthcare System

Fragmented Health FinancingFragmented Health Financing

Mindset of DOH and LGU officialsMindset of DOH and LGU officials

Supply-driven rather than needs-driven in Supply-driven rather than needs-driven in procuring medicines, vaccines, equipmentprocuring medicines, vaccines, equipment

Power dynamics between doctors and Power dynamics between doctors and other conventional health practitioners other conventional health practitioners and traditional health / holistic medicine and traditional health / holistic medicine practitionerspractitioners

NEEDSNEEDS

Since we are in a developing country Since we are in a developing country with a limited resource, then we with a limited resource, then we logically need more interventions logically need more interventions towards preventive and promotive towards preventive and promotive healthcare. healthcare.

We need affordable health goods and We need affordable health goods and services such that there would be wide-services such that there would be wide-range of options especially to those who range of options especially to those who have less economically (e.g. traditional, have less economically (e.g. traditional, alternative healing modalities).alternative healing modalities).

JUSTIFICATIONSJUSTIFICATIONS

To clarify, preventive measures not To clarify, preventive measures not to get sick and not just controlling to get sick and not just controlling the spread of diseases (e.g. Tips the spread of diseases (e.g. Tips on How to Control Dengue by on How to Control Dengue by mosquito nets, etc. but rather mosquito nets, etc. but rather focus more on proper nutrition like focus more on proper nutrition like eating Malunggay and Camote eating Malunggay and Camote Tops to strengthen resistance vs Tops to strengthen resistance vs Dengue and other diseases).Dengue and other diseases).

VisionVisionHave a healthy citizenry for a Have a healthy citizenry for a productive and fulfilling life!productive and fulfilling life!

““We want a healthcare system , which is We want a healthcare system , which is designed, planned, implemented and designed, planned, implemented and evaluated by the people/community evaluated by the people/community

members.”members.”

People as principal actor, owner, People as principal actor, owner, participants and beneficiary.participants and beneficiary.

Significantly reduced out-of-pocket Significantly reduced out-of-pocket expenses for healthcare.expenses for healthcare.

With this, what do we With this, what do we want our want our

healthcare system to healthcare system to become?become?

““The people have the right The people have the right and duty to participate and duty to participate

individually and collectively individually and collectively in the planning and in the planning and

implementation of their implementation of their healthcare.”healthcare.”

It is the responsibility of the individual It is the responsibility of the individual and, collectively, of the community.”and, collectively, of the community.”

Alma-ata Declaration during the International Conference on Primary Healthcare at USSR, September

6-12, 1978

GOALGOAL For people to be at the heart of the healthcare For people to be at the heart of the healthcare

system in terms of taking control and as informed system in terms of taking control and as informed participants/beneficiary of the system.participants/beneficiary of the system.

Access to affordable and quality healthcare for all.Access to affordable and quality healthcare for all.

QualityQuality would mean: would mean: Wide range of choices of evidence-based, safe Wide range of choices of evidence-based, safe

healthcare modalities / integration of different healthcare modalities / integration of different systems of medicinesystems of medicine

Rooted in the culture of the peopleRooted in the culture of the people

Preventive, promotive, curative and rehabilitative Preventive, promotive, curative and rehabilitative medical products and servicesmedical products and services

The People’s The People’s Healthcare SystemHealthcare System

A Human Rights Based A Human Rights Based Approach Approach

to Universal Health Careto Universal Health Care

through community-managed health plans

(CMHPs)

Health Promotion and Integrative Health Promotion and Integrative Health Care Sub-cluster: Health Care Sub-cluster:

RecommendationsRecommendations1)1) Increase the support for Community Health Increase the support for Community Health

Team or CHTsTeam or CHTsa.a. Provide training for interpersonal counseling and Provide training for interpersonal counseling and

community health education (preventing and curing basic community health education (preventing and curing basic illnesses using food , natural cures and home remedies)illnesses using food , natural cures and home remedies)

b.b. Provide additional allowance/incentive for personnel in the Provide additional allowance/incentive for personnel in the CHT doing health promotion activitiesCHT doing health promotion activities

c.c. Accredit barangay health workers who will be doing health Accredit barangay health workers who will be doing health promotion activities.promotion activities.

d.d. Capacitate and employ additional health professionals to Capacitate and employ additional health professionals to do health promotion at the community level (e.g. nurses)do health promotion at the community level (e.g. nurses)

Health Promotion and Health Promotion and Integrative Health Care Sub-Integrative Health Care Sub-cluster: Recommendationscluster: Recommendations

2)2) Provide specific funding for health promotion Provide specific funding for health promotion activities (policy development to inform LGUs, and activities (policy development to inform LGUs, and provide training for better health education) that provide training for better health education) that responds to NCDs (specifically diabetes, responds to NCDs (specifically diabetes, hypertension, and cancers)hypertension, and cancers)

3)3) Provide a specific budget item for the convergence Provide a specific budget item for the convergence of stakeholders/inter-agency on health promotion-of stakeholders/inter-agency on health promotion-related initiatives (health and non-health actors).related initiatives (health and non-health actors).

4)4) On the PITAHC budget, provide additional funding On the PITAHC budget, provide additional funding for the standardization of herbal medicine for the standardization of herbal medicine preparations, improvement of awareness preparations, improvement of awareness campaigns, and research and development.campaigns, and research and development.

Recommended Budget Recommended Budget (DOH NCHP)(DOH NCHP)

Program 2013 2014 (DOH proposed) 2014 (ABI Proposed)

Tobacco and Alcohol Control

221 Million

Physical activities and Exercise

58 Million

Healthy Eating Options

44 Million

Exclusive Breastfeeding

61 Million

Support to CHTs 7 Million

Support to Various NCD

Programs

100 Million

Support to HP Convergence

No suggestion pa

Total

Recommended Budget Recommended Budget (PITAHC)(PITAHC)

Program 2013 2014 (DOH proposed)

2014 (ABI Proposed)

Tobacco and Alcohol Control

Physical activities and Exercise

Total

Possible Sources of Possible Sources of Additional FundsAdditional Funds

Sin Tax (provision on the Sin Tax (provision on the attainment of MDGs and health attainment of MDGs and health awareness campaigns)awareness campaigns)

PDAFPDAF

Others (President’s Social Fund Others (President’s Social Fund and other lump sums)and other lump sums)

Health Promotion and Health Promotion and Integrative Health Care Sub-Integrative Health Care Sub-

cluster cluster Members:Members:

Fatima Cabanag (KAMAO/SENTRO)Fatima Cabanag (KAMAO/SENTRO)Aida Ishikawa (Concern Inc.)Aida Ishikawa (Concern Inc.)

Mercy Cepe (Health Integrated Development and Services)Mercy Cepe (Health Integrated Development and Services)Zella Pescadero (Philippine Nurses Association)Zella Pescadero (Philippine Nurses Association)

Marilyn Chaguile (SBSB)Marilyn Chaguile (SBSB)Roger Broal (Earth Saver’s Movement)Roger Broal (Earth Saver’s Movement)

Jofti Villena (Sarilaya)Jofti Villena (Sarilaya)Ronnel Lim (Healthcare without Harm)Ronnel Lim (Healthcare without Harm)

Elen Pedrosa (Alternative Health Foundation)Elen Pedrosa (Alternative Health Foundation)Ralph Emerson Degollacion (HealthJustice)Ralph Emerson Degollacion (HealthJustice)

MARAMING MARAMING SALAMAT PO!SALAMAT PO!