ON SONA 2024: Bursting the bubble

In his third State of the Nation Address (SONA), President Bongbong Marcos laid a lot of promises for the healthcare sector which are either ambitious or borderline delusional—merely reflecting on his shortcomings as a leader. It’s about time this bubble of bare minimum propositions burst. To this day Marcos is unable to cross the line of self-reflection and lackluster solutions. 

In his last SONA, healthcare was deemed as no longer a priority with the end of  the health emergency crisis post COVID-19 pandemic. Marcos ' intent to readjust health priorities and his contentment on the status of our healthcare is playing blind to the fact that our welfare system has one leg in a pit. On his path of readjusting the healthcare priorities, Marcos administration showed nothing but inconsistency. 

The lack of facilities, staff, surgical supplies, and inaccessible healthcare for rural areas remain the main obstacles to this date. Little to no progress was made over the years, Marcos is yet to work on these problems and stop being deluded by his idealistic plans and self-reflections.

With promises just as big or even bigger than what’s said today, his past SONA promises got shoved under the rug. 

His plans on the health sector are the same as with his last SONAs due to lack of improvement in the span of 2 years. Constantly remarking on centralized healthcare; through Philhealth, establishing mobile healthcare facilities, and improving nourishment. 

A staggering 60 million Filipinos experience “healthcare poverty,” the majority in rural areas but not uncommon in urban slums, based on Philanthropy Asia Alliance. In the Philippines, healthcare poverty refers to the challenges low-income people encounter in getting access to healthcare because of exorbitant expenditures, a dearth of healthcare facilities, and insufficient insurance coverage. This financial barrier often leads to delayed or inadequate treatment and worsens health outcomes and even death.

The Bagong Urgent Care and Ambulatory Services (BUCAS) is a component of DOH Secretary Teodoro Herbosa's "28 for 28 by 28" initiative, which aims to establish at least 28 BUCAS Centers to serve the 28 million Filipinos who most need access to high-quality healthcare services by 2028. A BUCAS Center is an intermediate health facility that provides urgent care and minor surgeries seven days a week. It serves as a link between primary care centers and hospitals, offering essential services to bridge the gap between these levels of care, centralizing healthcare.

With the launch of BUCAS, 20 urgent units were distributed across the country. Intended to bring hospitals closer and help Filipinos receive affordable-yet-adequate medical care, a promise fulfilled two years later. An archipelago with 82 provinces, and 52.02% of Filipinos living in rural areas based on MacroTrends census, these 20 available units barely cover a quarter of the country’s provinces, highly disappointing considering the two year delay. 

Despite uprooting 2.4 million Filipinos from poverty, malnutrition is still a problem in the country. According to the most recent survey results from the Social Weather Stations (SWS), the percentage of Filipino households experiencing "involuntary hunger" climbed to 14.2 percent in the first quarter of 2024, up 3.5 percent from the same time the previous year.

His solution on malnutrition involves the pre-existing First 1000 Days ni Baby and including breastfeeding and pregnant mothers as 4Ps beneficiaries. This proposal aims to improve 4Ps recipients' purchasing power, combat malnutrition and stunted growth of Filipino children.

The proposed solution is receptive, mechanizing the pre-existing First 1000 Days ni Baby program to not only focus on children but also their mothers. A commendable approach, but late considering the status quo. Based on the latest Global Nutrition Report 2022, the prevalence of stunting among children under five in the Philippines is 28.8%. This rate is higher than the Asian regional average of 21.8%.

Additionally, according to UNICEF “Every day, 95 children in the Philippines die from malnutrition.” Out of every 1,000 Filipino children, 27 die before reaching their fifth birthday. Furthermore, one-third of Filipino children experience stunting, meaning they are shorter than average for their age. If stunting occurs after age two, it can cause permanent and irreversible damage, and may even lead to death.

Furthermore on vaccination drive continuation, one of his SONA ‘23 projects. “Tuloy-tuloy ang ating paghahabol sa pagbakuna sa mga sanggol at mga bata lalo na sa Region 6 at BARMM." Approximately 49 percent of individuals in BARMM experience chronic malnutrition, and 45 percent of children under five are affected by stunting, making it the frontrunner in stunting rates across the country. Region 6 faces the same issue with a staggering 27% rate of stunting among the 8.2 million residents.

Philhealth is the focal health benefits distributor, the majority of Marcos’ projects in line with health are clustered under Philhealth. 

Finally after a long wait, Mental Health is recognized as a detrimental issue in the welfare of Filipinos. With the launch of Outpatient Mental Health Packages, this problem will alleviate the burden on impoverished mental health warriors. 

Over the years mental health in the country was a shunned health issue. Despite the recent enactment of the Mental Health Act and Universal Health Care Law in 2021, only 5% of healthcare spending goes to mental health in the country. Additionally, there are just 7.76 hospital beds and 0.41 psychiatrists for every 100,000 people, based on World Health Organization (2007) and Department of Health (2018). A very low average in comparison to our neighboring countries in Western Pacific Asia.

Mental illness is the third most common disability in the Philippines, affecting about six million people with depression and anxiety. The country ranks third in mental disorder rates in the Western Pacific. According to the 2020 WHO Special Initiative, over 3.6 million Filipinos have mental, neurological, or substance use disorders. Suicide rates are reported at 3.2 per 100,000 people, with higher rates among men. These figures may be underreported due to misclassification of some suicides. The WHO estimates that 154 million Filipinos suffer from depression, 1 million from schizophrenia, and 15.3 million from substance use disorders, with 877,000 suicide deaths annually.

This initiative is one of the few things the administration was able to revitalize in healthcare. Despite being late, the administration opened a big door to progress in destigmatizing mental illnesses. Financial benefits and medical care for mental health is available for beneficiaries age 10 and above. Mental health support includes P9,000 for general services and P16,000 for specialty services per person annually, available to those 10 years and older for psychiatric care, with no age limit for neurological services. The government aims to reduce premature mortality and enhance the quality of life for those with mental disorders. Efforts are underway to improve access to mental health services.

Cancer treatment is an area the country is yet to venture on, Filipinos often resort to traveling overseas for cancer treatment. A privilege not available for the vast majority of cancer patients in the country. In his plan to improve cancer treatment in the nation, cancer facilities PGH Cancer Center of DOH and UP-PGH Cancer Center were approved for construction–the first Public-Private Partnership approved during his term. Furthermore, benefits on cancer skyrocketed to 1000% percent–from a limit of 100,000 pesos to 1.4 million pesos.

He remarks these facilities as “godsend” yet these are only available in the National Capital Region much like the rest of cancer treatment centers; contradicting the probe on centralizing healthcare. Cancer treatment remains inaccessible and unattainable for common folks.

The Philippine healthcare system remains prohibitively expensive and shows signs of collapse, exacerbated by extensive brain-drain. Although measures are taken to make healthcare more accessible, they fall short of addressing the severity of the issue. Promises made to address long-standing problems are made with lackluster solutions. Marcos needs to break out of his idealistic bubble built on empty words.

A project named “Super Health Centers” aims to employ more doctors and nurses in local government units and more the following year. In line with these, he pledged improved programs in medicine and allied health, scholarships, funding for public medical schools, reviewed and upskilled programs as promised benefits for healthcare workers.

A highly ambitious plan when these medical workers are already underpaid, a doctor hired by an LGU earns only 65% of what a private-employed doctor earns. It’s pretty obvious that scholarships won’t improve the situation for underpaid and overworked doctors and nurses. We can go back a year and remember how a raise in salary was promised to medical workers—the allowance remains delayed to this date. 

Nearly half a year later, the same pleas were thrown to the government. "We fully demand that the funds for our COVID-19 allowances amounting to P537.M to be released," Sally Ejes, president of the Philippine Heart Center Employees Association-Association of Health Workers pressed.

An all time rise in brain-drain strikes the healthcare system annually. In 2023, around 31,000 Filipino nurses were deployed overseas, while 12,000 to 18,000 left the profession in the Philippines for reasons like retirement and career changes. The government should act swiftly on the problem of understaffing fueled by insufficient benefits and inadequate salary rather than bribes of unguaranteed grants.

These promises are long overdue, once again Filipinos have to settle with late and inadequate responses to prolonged issues. Eyes covered by rose-colored lenses, Marcos is unable to see that healthcare will remain inaccessible despite these efforts since the majority of infrastructures are set in NCR. 

Infrastructure remains one of the biggest problems in healthcare, while BUCAS is a great proposal. It isn’t really different from medical missions initiated by private institutions. With a 287 billion budget, building hospitals and providing sufficient medical equipment for provinces–especially in rural areas wouldn't hurt our pockets. This stands as a more concrete solution for the problems we face in the system. 

Moreover, the issue of brain-drain could easily be fixed if medical workers in the country actually got great benefits. The promises of scholarships in med school are good since it’s highly expensive, a factor that plays in the decline of health-allied job aspirants. Besides the expensive education, the biggest factor of discouragement is the gruesome working conditions; some only pursue medical degrees to work overseas. Without a guaranteed salary hike and unfulfilled wishes, the future of healthcare will remain dim. These people are the backbone of our healthcare system, if this issue is not resolved–we will go further down the drain.

Undeniably, these are good plans that would probably rebuild the country’s health. Nonetheless with the Marcos administration’s mishandling and a track record of providing weak solutions, uncertainty is inevitable. His due diligence in reflecting upon the issues faced by the country is a good trait but settling for reflecting on shortcomings as a leader and not doing much is putting more weight on the collapse of our country’s already subpar healthcare system. May this bubble of delusion burst. Delulu is not the solulu, we demand concrete plans, swift action and actual results.