Tuesday, March 31, 2009

Tambalan special issue

CBHP celebrates 35 years. click here for the stories.

Monday, March 30, 2009

RH bill misses the nail's head

Various arguments regarding House Bill 5043 otherwise known as the Reproductive Health Bill center on whether population control will actually alleviate poverty or whether the bill is moral or immoral. But community-based health programs say the proposed law missed the nail’s head.

Over population?

According to the National Statistics Office (NSO), there are three babies born every minute, almost two thousand in an hour, and almost four-thousand every day. This year, the NSO projects the population to balloon at 92.23-million making it one of the most populous countries in Asia. On the other hand, population density is 277 per square kilometer while the gross domestic product per capita is $3,400

In an online article by Emil Jurado, a columnist in the Manila Standard Today, he cited fifty other countries which have a much lower density whose per capita is also much lower. There are also thirty-six countries which are more densely populated, yet their GDP per capital is also much higher. He argued that all these simply mean that the few are not at all richer, and the many are not always poorer.

If over population is not the root cause of poverty in a country like the Philippines, what then is the source of the problem?

Wrong priorities

Recently, the P1.414-trillion 2009 national budget was approved by MalacaƱang. Simply put, the government has allotted each of the more than 90-million Filipinos with a P15,331 budget for year 2009 or a meager P42 per day. Instead of beefing up funds for social services, the government allotted P252-billion for debt service. Originally, the amount for debt servicing was cut by Congress from P 252 billion to P 202 billion, but Mrs. Arroyo’s veto restored the original amount for debt servicing. The Department of National Defense (DND) on the other hand will receive P56.5-billion, as funding for highly questionable wars and military spending. In contrast, government agencies who are expected to provide basic social services like the Department of Health (DoH) received a measly P27.9-billion. Meanwhile, the Department of Social Welfare and Development (DSWD) was allotted P10.5-billion (177% increase from last year’s allocation of P4.8-billion). However, bulk of the budget will be given away to dole-out programs such as donations and subsidies.

Beyond numbers

In a statement, Council for Health and Development (CHD) expressed that the issue of poverty should be viewed beyond the issue of an oversized population. Although the Reproductive Health Bill is “anchored on the rationale that sustainable human development is better assured with a manageable population of healthy, educated, and productive citizens,” CHD argued that managing the population through population control is not an assurance of genuine human or people’s development. They further stated that the worsening poverty is not caused by over population but by farmers’ problems of landlessness, workers’ lack of jobs and low wages, and government policies that favor big business interests over people’s welfare.

Accessible health care system

Reproductive health must be viewed and not separated from the overall context of people’s health. As the economy worsens, the state of the public health system also deteriorates. And with it, women’s health, especially those belonging to the marginalized sectors become all the more at stake. Year in and year out, the government continues to fail in its efforts to address people’s health problems. Consequently, many women’s and children’s lives are endangered. Moreover, the government’s hell-bent efforts to push for the privatization of public health facilities have made matters worse (e.g. collection of out-of-pocket fees in public hospitals) for poor women’s access to a comprehensive health care including reproductive health.

The debate on reproductive health vis a vis population can go on and on. But at the end of the day, it is the government’s responsibility to ensure accessible health services including reproductive health services. In particular, women should be provided with necessary information regarding reproductive health including all types of family planning methods to guide them in their decisions.#

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Tambalan December 2008

click here to read the whole issue.

The burden of renal diseases

About 1.2 million Filipinos today are suffering from kidney diseases, requiring either dialysis or a kidney transplant for them to live. Among the leading causes of kidney failure in the country are diabetes (41%), inflammation of the kidney (24%) and high blood pressure (22%).

According to the Department of Health, kidney disease is now one of the top ten causes of death among Filipinos wherein 7,000 die annually due to kidney malfunction. Because of the increasing number of Filipinos with kidney disease, it is now considered among the top seven health problems in the country.

Worldwide, there is also an alarming level of kidney disease with more than 500 million persons suffering from some form of kidney damage. Over 1.5 million of them are kept alive either through dialysis or transplantation. Every year, over 12 million individuals die prematurely of cardiovascular diseases linked to chronic kidney disease.

Costly treatment

In the Philippines, the treatment of kidney diseases is very costly and unaffordable.

Dialysis treatment uses artificial devices to perform the function of the kidney at about 15%, which is enough to sustain life but needs to be performed adequately on a regular basis (2-3 times a week) for life. Patients without sufficient dialysis are weak and show many of the symptoms that led to their diagnosis. Malnourished and unable to work, they tend to survive only until the next dialysis treatment. A patient has to spend P25,000 to P46,000 a month or P300,000 to P552,000 a year for his or her dialysis. Maintenance medication costs about P20,000 a month.

Kidney transplantation offers the best option for patients with kidney failure as shown by foreign and local studies, according to Romina Angangco Danguilan, chair of the NKTI’s Department of Adult Nephrology. In her study, she noted that the quality of life of a transplant patient is superior to one on dialysis. Kidney transplantation cost ranges from P500,000 to a million. Post-operation medication costs about P12,000 a month.

Because treatment is very expensive and draining to the pocket, it was reported that in 2007, only 73% of Filipino patients with kidney failure were able to afford necessary treatment.

No government support

Patients with PhilHealth coverage can only claim half of the cost of their treatment and cash out for the remaining cost. According to National Kidney Transplant Institute, only 15% of the partially-subsidized patients are PhilHealth members.

Poor kidney patients survive through assistance and borrowings from relatives and friends. Many of them had to beg around for funds from politicians and charitable organizations to pay for their treatment. Even patients who can afford admit that the burden of their treatment cost is heavily draining their families’ resources.

Dr. Lyn Almazan-Gomez, former president of the Philippine Society of Nephrologists said that there is no “free treatment” for kidney diseases. “It would be very draining for the government to shoulder treatment costs for renal patients considering the amount involved,” said Dr. Remedios De Belen-Uriarte, Department Manager of the Renal Disease Control Program of the National Kidney Transplant Institute (NKTI). She said that with limited income and resources, even NKTI can hardly afford to expand its services.

The NKTI is the government’s specialty health facility for kidney transplant and kidney-related diseases. In its out-patient hemodialysis unit, about two-thirds of the patients are pay patients who are able to afford the full amount of treatment costs and are given priority in the dialysis treatments. Only one-third of the patients are relatively poor service patients who avail of the discounts on hospital fees and charges given by the social services section but would have to wait for days to acquire a slot in the dialysis treatment. Regularity of dialysis treatment is very crucial for kidney patients because delay in such treatments would mean danger and may call for more expensive emergency procedures if not attended to immediately.

In 2007, NKTI records showed that of the 336 patients who were given transplantation procedures, 231 or 69% were pay patients and only 105 or 31% were service patients.

Prevention is best move

Prevention is the best move to counter the worsening problem on kidney disease in the country.

Kidney diseases are preventable, according to Dr. Uriarte. She emphasized the importance of early recognition of the causes to prevent or delay the development of kidney problems that usually end to kidney failure. That is why the REDCOP or Renal Disease Control Program under the NKTI, gives emphasis to the prevention aspect of controlling the spread of kidney diseases, according to Dr. Uriarte.

Playing a major role in the prevention of renal diseases, of course, is having a healthy lifestyle, which includes proper nutrition, regular exercise and timely physical check up.

The government appears to be giving less attention to combat the kidney disease problem. The Department of Health has no specific program to address this. Dr. Uriarte pointed out that no single centavo is given by the government in the campaign against renal diseases. She said that REDCOP depends on the funds that NKTI allocates to the program from the institution’s income.

Dr. Eleanor A. Jara, Executive Director of Council for Health and Development (CHD) said that it is the responsibility of the government to decisively exert the effort to address the worsening problem on renal diseases in the country given the prevailing economic difficulties confronting poor Filipinos these days.

Much more with the prevailing economic difficulties, the government must prioritize people’s health. This means increasing the share of health in the national budget from the less than one percent at present to as much as five percent of the country’s total production following the World Health Organization’s prescription. It also means unburdening the people in paying onerous debts incurred by the government and decreasing the budget for huge military spending.

PIA Press Release, 12-04-2008; REDCOP/NKTI

The Dengue Chronicles

Dengue fever, an infectious tropical fever contracted through mosquito bites used to occur only during rainy season.

In the Philippines though, it has become an all-year round threat. In the first six months of the year 2008, there were 15,061 people afflicted by dengue with 172 deaths. Manila has the highest incidence rate, followed by Quezon City, Caloocan and Pasig.

Even at the start of the 2008, records at the San Lazaro Hospital in Manila have shown that there has been 152 percent increase in the number of dengue cases compared to the same period in 2007.

Dengue also hit the provinces of Batangas, Laguna, Rizal, Negros Occidental, Cagayan de Oro and Misamis Oriental. Again, compared with 2007, in Negros Occidental, dengue cases have increased by 50 percent while in Northern Mindanao, there was a 69 percent increase.

A disease of poverty

Dengue fever is a disease attributable to poverty. The National Center for National Disease Prevention and Control said that there was a direct proportion between population density and dengue.

People from congested communities, where mosquitoes can easily find breeding place on worn-out tires, stagnant drainage and dirty surroundings, are more prone to this disease.

Sadly, detection of dengue usually comes late due to financial constraints of the people affected especially with the very expensive cost of health care even in the government hospitals. These contribute to the increase in the mortality of dengue victims yearly.

Sound public health care system

Even with the few existing laws that mandate the Local Government Units and other government agencies to involve themselves in disease control programs such as the Code on Sanitation (1975), Local Government Code (1993), Ecological Solid Waste Management (2000), and the Clean Water Act (2004) and the National Dengue Control Program, communicable diseases remain to be the top leading causes of mortality and morbidity in the country.

The worsening threat of dengue fever is but a manifestation of government neglect of the public health care system.

Fighting dengue fever requires more than stopgap solutions. It requires a government that prioritizes the health of its people - meaning a public health care that is comprehensive and responsive to our needs and with adequate budget allocation.

First and foremost, dengue is a preventable illness.

Moreover, the steps to prevent cointracting dengue are very simple and easy to follow. With a sound and pro-active public health care system, Dengue will be easier to combat. On the other hand, it also requires mobilization and active participation of the people in the communities.

Launching campaigns that include awareness raising and education is also an effective solution. Organizations within communities should actively cooperate with other local agencies to form measures in prevention and management of dengue.

Again, dengue is a preventable disease and as we all know, as in every disease, prevention is better than cure.#