The Philippine Health Care System: An Update Jaime Z. Galvez Tan, MD, MPH jjjj zzzz gggg aaaa llll...

The Philippine Health Care System: An Update

Jaime Z. Galvez Tan, MD, [email protected]+63917 853 7798

A Community Participatory Exercise

On a separate sheet of paper, write one word that you feel would best describe the Philippine Health Situation

The Philippines 2006

High population growth rateTrends in Population and DevelopmentAt 2.36% population growth rate:2 M annual increase in population or 5,479 per day increase206 babies born every hour or 4 every minute85 M estimated population at the end 2005 (NSO)

The Good News..BUT

Source: National Statistics Office, 2006

Chart11

38.4

36

30

Year

per 1000 live births

Infant Mortality Rate

Data1

Death by Attendance in 5-yr Interval: Philippines 1965-2002

YearTotalAttendedNot Attended% of Attended% of Unattended

1965234,93548,050186,88520.45%79.55%

1970234,03862,025172,01326.50%73.50%

1975271,13698,220172,91636.23%63.77%

1980298,00692,808205,19831.14%68.86%

1985334,663114,125220,53834.10%65.90%

1990313,890129,622184,26841.30%58.70%

1995324,737135,328189,40941.67%58.33%

2000366,931130,501236,43035.57%64.43%

2002396,297130,192266,10532.85%67.15%

Chart1

0.20452465580.7954753442

0.2650210650.734978935

0.36225362920.6377463708

0.31142997120.6885700288

0.34101469240.6589853076

0.41295358250.5870464175

0.41673107780.5832689222

0.3556554230.644344577

0.32852128580.6714787142

Year

Percent

Percentage of Medically-Attended Deaths

Data2

Deaths by Place of Occurrence, by Type of Attendant: Philippines, 2002

REGIONTotalType of AttendancePercentage

AttendedUnattendedAttendedUnattended

Philippines396,297130,192266,10532.85%67.15%

NCR65,13035,96129,16955.21%44.79%

CAR5,5551,9743,58135.54%64.46%

I28,3227,44620,87626.29%73.71%

II14,4173,83110,58626.57%73.43%

III44,59413,04231,55229.25%70.75%

IVA49,78114,23435,54728.59%71.41%

IVB9,8212,8316,99028.83%71.17%

V25,7186,24819,47024.29%75.71%

VI38,40612,09226,31431.48%68.52%

VII33,6829,12624,55627.09%72.91%

VIII18,2274,46013,76724.47%75.53%

IX9,9932,9897,00429.91%70.09%

X14,8074,8109,99732.48%67.52%

XI16,3655,37110,99432.82%67.18%

XII10,5572,7527,80526.07%73.93%

XIII8,1232,2865,83728.14%71.86%

ARMM2,7997392,06026.40%73.60%

Chart2

0.4478581299

0.6446444644

0.7370948379

0.73427204

0.7075391308

0.7140676162

0.7117401487

0.7570573139

0.6851533615

0.7290540942

0.7553080595

0.7008906234

0.6751536435

0.6717995723

0.7393198825

0.7185768805

0.7359771347

REGION

Percent

Unattended Deaths by Place of Occurence: Philippines, 2002

Data2a




Philippines396,297130,192266,10532.85%67.15%

NCR65,13035,96129,16955.21%44.79%

CAR5,5551,9743,58135.54%64.46%

Region I - Ilocos28,3227,44620,87626.29%73.71%

Region II - Cagayan Valley14,4173,83110,58626.57%73.43%

Region III - Central Luzon44,59413,04231,55229.25%70.75%

Region IVA - (CALABARZON)49,78114,23435,54728.59%71.41%

Region IVB - (MIMAROPA)9,8212,8316,99028.83%71.17%

Region V - Bicol25,7186,24819,47024.29%75.71%

Region VI - Western Visayas38,40612,09226,31431.48%68.52%

Region VII - Central Visayas33,6829,12624,55627.09%72.91%

Region VIII - Eastern Visayas18,2274,46013,76724.47%75.53%

Region IX - Zamboanga Peninsula9,9932,9897,00429.91%70.09%

Region X - Northern Mindanao14,8074,8109,99732.48%67.52%

Region XI - Davao Region16,3655,37110,99432.82%67.18%

Region XII - SOCSARGEN10,5572,7527,80526.07%73.93%

Region XIII - Caraga8,1232,2865,83728.14%71.86%

ARMM2,7997392,06026.40%73.60%

Data3

Proportion of mothers delivered by a health professional

Year%

199328.2

199834.2

200359.8

Proportion of Mothers Delivering at Home

Year%

199371.5

199865.5

200361.4

Proportion of Infants Exclusively Breastfed for:

Age199319982003

Infant Mortality declining but still higher than other Southeast Asian countriesChild Health


Chart14

209

172

Year

Ratio

Maternal Mortality Ratio

Data1



1965234,93548,050186,88520.45%79.55%

1970234,03862,025172,01326.50%73.50%

1975271,13698,220172,91636.23%63.77%

1980298,00692,808205,19831.14%68.86%

1985334,663114,125220,53834.10%65.90%

1990313,890129,622184,26841.30%58.70%

1995324,737135,328189,40941.67%58.33%

2000366,931130,501236,43035.57%64.43%

2002396,297130,192266,10532.85%67.15%

Chart1

0.20452465580.7954753442

0.2650210650.734978935

0.36225362920.6377463708

0.31142997120.6885700288

0.34101469240.6589853076

0.41295358250.5870464175

0.41673107780.5832689222

0.3556554230.644344577

0.32852128580.6714787142

Year

Percent


Data2




Philippines396,297130,192266,10532.85%67.15%

NCR65,13035,96129,16955.21%44.79%

CAR5,5551,9743,58135.54%64.46%

I28,3227,44620,87626.29%73.71%

II14,4173,83110,58626.57%73.43%

III44,59413,04231,55229.25%70.75%

IVA49,78114,23435,54728.59%71.41%

IVB9,8212,8316,99028.83%71.17%

V25,7186,24819,47024.29%75.71%

VI38,40612,09226,31431.48%68.52%

VII33,6829,12624,55627.09%72.91%

VIII18,2274,46013,76724.47%75.53%

IX9,9932,9897,00429.91%70.09%

X14,8074,8109,99732.48%67.52%

XI16,3655,37110,99432.82%67.18%

XII10,5572,7527,80526.07%73.93%

XIII8,1232,2865,83728.14%71.86%

ARMM2,7997392,06026.40%73.60%

Chart2

0.4478581299

0.6446444644

0.7370948379

0.73427204

0.7075391308

0.7140676162

0.7117401487

0.7570573139

0.6851533615

0.7290540942

0.7553080595

0.7008906234

0.6751536435

0.6717995723

0.7393198825

0.7185768805

0.7359771347

REGION

Percent


Data2a




Philippines396,297130,192266,10532.85%67.15%

NCR65,13035,96129,16955.21%44.79%

CAR5,5551,9743,58135.54%64.46%

Region I - Ilocos28,3227,44620,87626.29%73.71%





Region V - Bicol25,7186,24819,47024.29%75.71%









ARMM2,7997392,06026.40%73.60%

Data3


Year%

199328.2

199834.2

200359.8


Year%

199371.5

199865.5

200361.4


Age199319982003

Maternal Mortality Across Asian Countries

OverweightTrends in the Prevalence of Malnutrition among 0-5 Year-Old Children,Philippines 1989-90 to 2003UnderweightStuntingWasting

Yes Declining Malnutrition but

A cohort of 3.3. million children 0-5 years old remain in chronic malnutrition throughout their pre-school years.This means one fourth of Filipino pre-school children are always at high risk of mental and physical retardation.

OverweightUnderweightStuntingTrends in the Prevalence of Malnutrition of 6-10 Year-Old Children,Philippines 1989-90 to 2003

Yes among elementary school children, declining malnutrition butA cohort of 3.6 million school children age 6 to 10 years old remain in chronic malnutrition during their school years. They would likely not perform well and most likely drop out.

This means one fourth of our future work force will be physically and mentally deficient.

Source: National Demographic and Health Surveys ; National Statistics Office, 2006

Chart4

28.2

34.2

59.8

Year

Proportion

Proportion of Mothers Delivered By A Health Professional

Data1



1965234,93548,050186,88520.45%79.55%

1970234,03862,025172,01326.50%73.50%

1975271,13698,220172,91636.23%63.77%

1980298,00692,808205,19831.14%68.86%

1985334,663114,125220,53834.10%65.90%

1990313,890129,622184,26841.30%58.70%

1995324,737135,328189,40941.67%58.33%

2000366,931130,501236,43035.57%64.43%

2002396,297130,192266,10532.85%67.15%

Chart1

0.20452465580.7954753442

0.2650210650.734978935

0.36225362920.6377463708

0.31142997120.6885700288

0.34101469240.6589853076

0.41295358250.5870464175

0.41673107780.5832689222

0.3556554230.644344577

0.32852128580.6714787142

Year

Percent


Data2




Philippines396,297130,192266,10532.85%67.15%

NCR65,13035,96129,16955.21%44.79%

CAR5,5551,9743,58135.54%64.46%

I28,3227,44620,87626.29%73.71%

II14,4173,83110,58626.57%73.43%

III44,59413,04231,55229.25%70.75%

IVA49,78114,23435,54728.59%71.41%

IVB9,8212,8316,99028.83%71.17%

V25,7186,24819,47024.29%75.71%

VI38,40612,09226,31431.48%68.52%

VII33,6829,12624,55627.09%72.91%

VIII18,2274,46013,76724.47%75.53%

IX9,9932,9897,00429.91%70.09%

X14,8074,8109,99732.48%67.52%

XI16,3655,37110,99432.82%67.18%

XII10,5572,7527,80526.07%73.93%

XIII8,1232,2865,83728.14%71.86%

ARMM2,7997392,06026.40%73.60%

Chart2

0.4478581299

0.6446444644

0.7370948379

0.73427204

0.7075391308

0.7140676162

0.7117401487

0.7570573139

0.6851533615

0.7290540942

0.7553080595

0.7008906234

0.6751536435

0.6717995723

0.7393198825

0.7185768805

0.7359771347

REGION

Percent


Data2a




Philippines396,297130,192266,10532.85%67.15%

NCR65,13035,96129,16955.21%44.79%

CAR5,5551,9743,58135.54%64.46%

Region I - Ilocos28,3227,44620,87626.29%73.71%





Region V - Bicol25,7186,24819,47024.29%75.71%









ARMM2,7997392,06026.40%73.60%

Data3


Year%

199328.2

199834.2

200359.8


Year%

199371.5

199865.5

200361.4


Age199319982003

Source: National Demographic and Health Surveys; National Statistics Office, 2006

Chart6

71.5

65.5

61.4

Year

Proportion


Data1



1965234,93548,050186,88520.45%79.55%

1970234,03862,025172,01326.50%73.50%

1975271,13698,220172,91636.23%63.77%

1980298,00692,808205,19831.14%68.86%

1985334,663114,125220,53834.10%65.90%

1990313,890129,622184,26841.30%58.70%

1995324,737135,328189,40941.67%58.33%

2000366,931130,501236,43035.57%64.43%

2002396,297130,192266,10532.85%67.15%

Chart1

0.20452465580.7954753442

0.2650210650.734978935

0.36225362920.6377463708

0.31142997120.6885700288

0.34101469240.6589853076

0.41295358250.5870464175

0.41673107780.5832689222

0.3556554230.644344577

0.32852128580.6714787142

Year

Percent


Data2




Philippines396,297130,192266,10532.85%67.15%

NCR65,13035,96129,16955.21%44.79%

CAR5,5551,9743,58135.54%64.46%

I28,3227,44620,87626.29%73.71%

II14,4173,83110,58626.57%73.43%

III44,59413,04231,55229.25%70.75%

IVA49,78114,23435,54728.59%71.41%

IVB9,8212,8316,99028.83%71.17%

V25,7186,24819,47024.29%75.71%

VI38,40612,09226,31431.48%68.52%

VII33,6829,12624,55627.09%72.91%

VIII18,2274,46013,76724.47%75.53%

IX9,9932,9897,00429.91%70.09%

X14,8074,8109,99732.48%67.52%

XI16,3655,37110,99432.82%67.18%

XII10,5572,7527,80526.07%73.93%

XIII8,1232,2865,83728.14%71.86%

ARMM2,7997392,06026.40%73.60%

Chart2

0.4478581299

0.6446444644

0.7370948379

0.73427204

0.7075391308

0.7140676162

0.7117401487

0.7570573139

0.6851533615

0.7290540942

0.7553080595

0.7008906234

0.6751536435

0.6717995723

0.7393198825

0.7185768805

0.7359771347

REGION

Percent


Data2a




Philippines396,297130,192266,10532.85%67.15%

NCR65,13035,96129,16955.21%44.79%

CAR5,5551,9743,58135.54%64.46%

Region I - Ilocos28,3227,44620,87626.29%73.71%





Region V - Bicol25,7186,24819,47024.29%75.71%









ARMM2,7997392,06026.40%73.60%

Data3


Year%

199328.2

199834.2

200359.8


Year%

199371.5

199865.5

200361.4


Age199319982003

Quality of Antenatal Care 2003Percentage of women who received the following during antenatal care:Blood sample taken 37.6Urine sample taken 46.7Informed of signs of pregnancy complications 49.1Height measured 59.7Weight measured 87.9Blood pressure taken 90.3

Now

The Bad News


Data1



1965234,93548,050186,88520.45%79.55%

1970234,03862,025172,01326.50%73.50%

1975271,13698,220172,91636.23%63.77%

1980298,00692,808205,19831.14%68.86%

1985334,663114,125220,53834.10%65.90%

1990313,890129,622184,26841.30%58.70%

1995324,737135,328189,40941.67%58.33%

2000366,931130,501236,43035.57%64.43%

2002396,297130,192266,10532.85%67.15%

Chart1

0.20452465580.7954753442

0.2650210650.734978935

0.36225362920.6377463708

0.31142997120.6885700288

0.34101469240.6589853076

0.41295358250.5870464175

0.41673107780.5832689222

0.3556554230.644344577

0.32852128580.6714787142

Attended

Unattended

Year

Percent

Death by Attendance in 5-year Intervals, Philippines 1965-2002

Data2




Philippines396,297130,192266,10532.85%67.15%

NCR65,13035,96129,16955.21%44.79%

CAR5,5551,9743,58135.54%64.46%

I28,3227,44620,87626.29%73.71%

II14,4173,83110,58626.57%73.43%

III44,59413,04231,55229.25%70.75%

IVA49,78114,23435,54728.59%71.41%

IVB9,8212,8316,99028.83%71.17%

V25,7186,24819,47024.29%75.71%

VI38,40612,09226,31431.48%68.52%

VII33,6829,12624,55627.09%72.91%

VIII18,2274,46013,76724.47%75.53%

IX9,9932,9897,00429.91%70.09%

X14,8074,8109,99732.48%67.52%

XI16,3655,37110,99432.82%67.18%

XII10,5572,7527,80526.07%73.93%

XIII8,1232,2865,83728.14%71.86%

ARMM2,7997392,06026.40%73.60%

Chart2

0.4478581299

0.6446444644

0.7370948379

0.73427204

0.7075391308

0.7140676162

0.7117401487

0.7570573139

0.6851533615

0.7290540942

0.7553080595

0.7008906234

0.6751536435

0.6717995723

0.7393198825

0.7185768805

0.7359771347

REGION

Percent


Data2a




Philippines396,297130,192266,10532.85%67.15%

NCR65,13035,96129,16955.21%44.79%

CAR5,5551,9743,58135.54%64.46%

Region I - Ilocos28,3227,44620,87626.29%73.71%





Region V - Bicol25,7186,24819,47024.29%75.71%









ARMM2,7997392,06026.40%73.60%

Data3


Year%

199328.2

199834.2

200359.8


Year%

199371.5

199865.5

200361.4


Age199319982003

Source: National Demographic and Health Surveys; National Statistics Office, 2006

Chart10

42.726.413.2

57.740.120

52.535.416.1


Chart13

69.4

58.2

65.3

64.5

65.2

61.3

62.9

59.9

Year

Proportion

Proportion of Fully Immunized Children

Data1



1965234,93548,050186,88520.45%79.55%

1970234,03862,025172,01326.50%73.50%

1975271,13698,220172,91636.23%63.77%

1980298,00692,808205,19831.14%68.86%

1985334,663114,125220,53834.10%65.90%

1990313,890129,622184,26841.30%58.70%

1995324,737135,328189,40941.67%58.33%

2000366,931130,501236,43035.57%64.43%

2002396,297130,192266,10532.85%67.15%

Chart1

0.20452465580.7954753442

0.2650210650.734978935

0.36225362920.6377463708

0.31142997120.6885700288

0.34101469240.6589853076

0.41295358250.5870464175

0.41673107780.5832689222

0.3556554230.644344577

0.32852128580.6714787142

Year

Percent


Data2




Philippines396,297130,192266,10532.85%67.15%

NCR65,13035,96129,16955.21%44.79%

CAR5,5551,9743,58135.54%64.46%

I28,3227,44620,87626.29%73.71%

II14,4173,83110,58626.57%73.43%

III44,59413,04231,55229.25%70.75%

IVA49,78114,23435,54728.59%71.41%

IVB9,8212,8316,99028.83%71.17%

V25,7186,24819,47024.29%75.71%

VI38,40612,09226,31431.48%68.52%

VII33,6829,12624,55627.09%72.91%

VIII18,2274,46013,76724.47%75.53%

IX9,9932,9897,00429.91%70.09%

X14,8074,8109,99732.48%67.52%

XI16,3655,37110,99432.82%67.18%

XII10,5572,7527,80526.07%73.93%

XIII8,1232,2865,83728.14%71.86%

ARMM2,7997392,06026.40%73.60%

Chart2

0.4478581299

0.6446444644

0.7370948379

0.73427204

0.7075391308

0.7140676162

0.7117401487

0.7570573139

0.6851533615

0.7290540942

0.7553080595

0.7008906234

0.6751536435

0.6717995723

0.7393198825

0.7185768805

0.7359771347

REGION

Percent


Data2a




Philippines396,297130,192266,10532.85%67.15%

NCR65,13035,96129,16955.21%44.79%

CAR5,5551,9743,58135.54%64.46%

Region I - Ilocos28,3227,44620,87626.29%73.71%





Region V - Bicol25,7186,24819,47024.29%75.71%









ARMM2,7997392,06026.40%73.60%

Data3


Year%

199328.2

199834.2

200359.8


Year%

199371.5

199865.5

200361.4


Age199319982003

Deficient SR< 10 ug/dLDeficient and Low SR < 20 ug/dlPrevalence of Vitamin A Deficiency among 6m 5y old children, 1993- 2003Vitamin A Deficiency: a major cause of childhood illnesses and deaths

Prevalence of anemia among children: 1993, 1998, and 2003Anemia: a major cause of poor school performance and school drop-out

Source: The Filipino Poverty Report Card, World Bank, Social Weather Station 2001

Chart4

27.9635.42

116.78117.34

123.78136.96

Income Class

$

Expenditures for Medicine within the Mean Health Expenditure

Sheet1

PesoDollar

1991138027.6

1992172934.58

19935935118.7

19948726174.52

199510430208.6

199612479249.58

199715842316.84

199817339346.78

199919351387.02

200022206444.12

200122258445.16

200217838356.76

Sheet1

Year

billion Php

Local Government Health Expenditure

Sheet2

Year

billion dollars


Sheet3

Bottom 30%Middle 30%Top 40%Bottom 30%Middle 30%Top 40%

Medicine1,3985,8396,18927.96116.78123.78

1,7715,8676,84835.42117.34136.96

3,16911,70613,03763.38234.12260.74

Sheet3

Income Class

$

Expenditures for Medicine within the Mean Health Expenditure

Why the Good News but.Why the Bad News. An analysis of the some of the immediate causes

Source: National Statistical Coordination Board, 2005

Chart1

2.53

2.03

1.81

1.55

1.6

1.84

1.4

1.1

Year

%

Proportion of the Health Budget in the Philippine National Budget

Sheet1

19982.53

19992.03

20001.81

20011.55

20021.6

20031.84

20041.4

20051.1

Sheet2

Sheet3


Chart1

2.53

2.03

1.81

1.55

1.6

1.84

1.4

1.1

Year

%


Sheet1

19982.53

19992.03

20001.81

20011.55

20021.6

20031.84

20041.4

20051.1

Chart2

2.9

2.9

3.2

3.2

3.4

3.4

3.5

3.4

3.3

3.2

3

2.7

2.9

Year

%

Percentage Share of Health Expenditure to GNP, Philippines, 1991-2003

Sheet2

19912.9

19922.9

19933.2

19943.2

19953.4

19963.4

19973.5

19983.4

19993.3

20003.2

20013

20022.7

20032.9

Sheet3


Chart3

27.6

34.58

118.7

174.52

208.6

249.58

316.84

346.78

387.02

444.12

445.16

356.76

Year

billion US dollars


Sheet1

PesoDollar

1991138027.6

1992172934.58

19935935118.7

19948726174.52

199510430208.6

199612479249.58

199715842316.84

199817339346.78

199919351387.02

200022206444.12

200122258445.16

200217838356.76

Sheet1

0

0

0

0

0

0

0

0

0

0

0

0

Year

billion Php


Sheet2

0

0

0

0

0

0

0

0

0

0

0

0

Year

billion dollars


Sheet3

Source: NDHS, 2003

Chart1

2.53

2.03

1.81

1.55

1.6

1.84

1.4

1.1

Year

%


Sheet1

19982.53

19992.03

20001.81

20011.55

20021.6

20031.84

20041.4

20051.1

Chart2

2.9

2.9

3.2

3.2

3.4

3.4

3.5

3.4

3.3

3.2

3

2.7

2.9

Year

%

Percentage Share of Health Expenditure to GNP, Philippines, 1991-2003

Sheet2

19912.9

19922.9

19933.2

19943.2

19953.4

19963.4

19973.5

19983.4

19993.3

20003.2

20013

20022.7

20032.9

Chart3

0.7

0.43

0.27

0.15

0.11

0.02

0.02

Philippine Health Insurance Program, 2003

Sheet3

Non-members70%

Privately Employed43%

Government Employed27%

Individually Paying15%

Indigents/Sponsored11%

OFWs2%

Others2%

If all data accounted for, at least 100,000 Nurses left in the last 10 ten years the highest volume in historyNote: full USA data not accounted for Source: Professional RegulationCommission, 2004

Chart2

6699

7584

4734

4242

4591

5413

7683

13536

11911

18450

VOLUME

Deployment of Filipino Nurses, 1994-2003

Sheet1

VOLUME

19946,699

19957,584

19964,734

19974,242

19984,591

19995,413

20007,683

200113,536

200211,911

200318,450

TOTAL84,843

Sheet1

0

0

0

0

0

0

0

0

0

0

VOLUME

Deploment of Filipino Nurses, 1994-2003

Sheet2

Sheet3

Source: PRC, 2005

Chart1

61.45

58.24

54.22

50.02

55.79

49.86

49.2

53.5

44.75

48.18

49.68

51.6

board passers

Year

Nursing Licensure Board Passers

Sheet1

YEARNumberNumberPassing

of Examineesof PassersRate

199441,45925,47761.45

199538,68922,53258.24

199625,16313,64354.22

199719,5469,77650.02

199817,1019,54155.79

199913,1526,55849.86

20009,3514,60049.2

20018,2814,43053.5

20029,4534,23144.75

200315,6247,52848.18

200425,32512,58149.68

200525,95150,28051.6

Sheet1

0

0

0

0

0

0

0

0

0

0

0

0

board passers

Year

Nursing Licensure Board Passers

Sheet2

Sheet3

Source: Calculated, PRC Data, 2004Performance of Schools in the NURSING Licensure Examination, 1994-1998, 2001, and 2002

Chart2

68113

116124

15087

Passing Rate of less than 50%

Passing Rate of 50% and above

Sheet1

Year documentedCountryNumber of DoctorsRank

(as supplying country)

1999Australia113

2002Canada261

2004Unites States17, 297

Sheet2

Sheet3

Source: Professional Regulatory Commission, 2004Nursing Board Performance

The Phenomenon of Doctors Becoming Nurses

Nursing MedicsOnly in the Philippines before 2005(now no more)

Doctors Becoming NursesAround 3,000 doctors have left as nurses since 2000In 2003-2005, more than 4000 physicians took the Philippine Board of Nursing Licensure Exams Currently around 3,000 doctors are enrolled in 45 nursing schools offering customized courses for physicians all over the country

Nursing Medics: Who Are They?Around 80% of government physicians have taken up or are enrolled in nursingThey come from all kinds of specialtiesTheir age range from 25 years old to 65 years oldYears of practice as a physician range from zero to 38 yearsMore females than males; They come from all regions of the countrySource: KII, Personal Study 2004

Consequences Series #1Decline in the interest of young Filipinos to study medicine evidenced by a drop of 50% in NMAT examinees with 2001 as baselineDecline in the enrolment in medical schools an average of 30%; 3 medical schools have closed downDecline in the applicants for medical residency positions to become specialists

Source: CEM, 2004

Chart1

5049

5360

5814

5730

5948

6121

6245

6192

5853

4475

4070

Year

Examinees

NMAT Examinees (1994-2004)

Sheet1

YEARVOLUME% Increase

199450490%

199553606%

199658148%

19975730-1%

199859484%

199961213%

200062452%

20016192-1%

20025853-6%

20034475-24%

20044070-9%

Apr-051131

Sheet1

0

0

0

0

0

0

0

0

0

0

0


Sheet2

Sheet3

Overseas Filipino Workers (OFWs) Remittances

Source: Central Bank of the Philippines, 2005

Chart1

6.79

6.05

6.03

7.19

7.64

8.5

10.2

In Billion US$

OFW Remittance in Billion US Dollars, 1999-2005

Sheet1

In Billion US$

19996.79

20006.05

20016.03

20027.19

20037.64

20048.5

200510.2

Sheet1

0

0

0

0

0

0

0

In Billion US$

OFW Remittance in Billion US Dollars, 1999-2005

Sheet2

Sheet3

NMATNMAT

Chart1

5049

5360

5814

5730

5948

6121

6245

6192

5853

4475

4070

2912

VOLUME


Sheet1

YEARVOLUME% Increase

199450490%

199553606%

199658148%

19975730-1%

199859484%

199961213%

200062452%

20016192-1%

20025853-6%

20034475-24%

20044070-9%

20052912-28%

Sheet1

VOLUME


Sheet2

Sheet3

Consequences Series #2200 hospitals have closed down within the past two years no more doctors and nurses800 hospitals have partially closed (with one to two wards closed) lack of doctors and nursesNurse to patient ratios in provincial and district hospitals now 1: 40 to 1: 60Loss of highly skilled nurses in all hospitals across the country

Why these bad bad sad sad news!

An analysis of the some of the major underlying causes

IncomeAnnual average family income: US$2,619 (FIES 2000)Poverty incidence: 34% or 25.8 million people (NEDA 2001)Poverty Self-Rating by Filipinos: March 2001: 64% are poor (50 M) Oct 2005: 75% are poor (64 M) (Pulse Asia Surveys 2001-2005)

In US DollarsSource: WDI Online, World BankPhilippine Per Capita Gross National Income

Chart5

1080

1040

1030

1030

1020

Philippines

Thailand

COUNTRY_NAMEIND1_DESC19981999200020012002

IndonesiaGDP growth (annual %)-13.130.794.923.443.66

IndonesiaGNI per capita, Atlas method (current US$)670590570680710

IndonesiaGNI, Atlas method (current US$)1.35E+111.20E+111.18E+111.43E+111.50E+11

IndonesiaMalnutrition prevalence, weight for age (% of children under 5)29.526.325....

MalaysiaGDP growth (annual %)-7.366.148.330.454.21

MalaysiaGNI per capita, Atlas method (current US$)36303380338034003540

MalaysiaGNI, Atlas method (current US$)8.05E+107.67E+107.86E+108.10E+108.60E+10

MalaysiaMalnutrition prevalence, weight for age (% of children under 5)..........

PhilippinesGDP growth (annual %)-0.583.44.383.224.56

PhilippinesGNI per capita, Atlas method (current US$)10801040103010301020

PhilippinesGNI, Atlas method (current US$)7.92E+107.82E+107.87E+108.08E+108.15E+10

PhilippinesMalnutrition prevalence, weight for age (% of children under 5)31.8........

SingaporeGDP growth (annual %)-0.866.429.41-2.372.25

SingaporeGNI per capita, Atlas method (current US$)2351022660227802110020690

SingaporeGNI, Atlas method (current US$)9.22E+108.96E+109.15E+108.72E+108.61E+10

SingaporeMalnutrition prevalence, weight for age (% of children under 5)..........

ThailandGDP growth (annual %)-10.514.454.651.945.22

ThailandGNI per capita, Atlas method (current US$)20801980202019601980

ThailandGNI, Atlas method (current US$)1.25E+111.19E+111.23E+111.20E+111.22E+11

ThailandMalnutrition prevalence, weight for age (% of children under 5)..........

VietnamGDP growth (annual %)5.764.776.796.847.1

VietnamGNI per capita, Atlas method (current US$)350360390410430

VietnamGNI, Atlas method (current US$)2.68E+102.81E+103.03E+103.28E+103.49E+10

VietnamMalnutrition prevalence, weight for age (% of children under 5)39.836.734....

IndonesiaGNI per capita, Atlas method (current US$)670590570680710

MalaysiaGNI per capita, Atlas method (current US$)36303380338034003540

PhilippinesGNI per capita, Atlas method (current US$)10801040103010301020

ThailandGNI per capita, Atlas method (current US$)20801980202019601980

VietnamGNI per capita, Atlas method (current US$)350360390410430

ThailandMalaysia

1998208019983630

1999198019993380

2000202020003380

2001196020013400

2002198020023540

20032003

VietnamIndonesia

19983501998670

19993601999590

20003902000570

20014102001680

20024302002710

20032003

Philippines

19981080

19991040

20001030

20011030

20021020

2003

Thailand

0

0

0

0

0

Thailand

0

0

0

0

0

Vietnam

0

0

0

0

0

Malaysia

0

0

0

0

0

Indonesia

0

0

0

0

0

Philippines

EmploymentTotal labor force: 35 MillionTotal Unemployment Rate: 10.1% (LFS Oct. 03)Total Underemployment Rate: 15.7% ( LFS Oct. 03)

Source: http://www.bsp.gov.ph/statistics/spei/tab46b.htm

Chart10

0.087

0.1005

0.098

0.112

0.111

0.114

0.114

Year

Unemployment Rate, Philippines 2003

Dollar Peso Exchange Rate

-26.21

-26.31

-42.66

-38.4

-40.42

-50.97

-51.4

-53.56

-55.52

Sheet1

Banko Sentral ng Pilipinas Data

Dollar Peso Exchange Rate

Jan.199626.2110073.79-26.211996-26.21

199726.3110073.69-26.311997-26.31

199842.6610057.34-42.661998-42.66

199938.4010061.60-38.401999-38.40

200040.4210059.58-40.422000-40.42

200150.9710049.03-50.972001-50.97

200251.4010048.60-51.402002-51.40

200353.5610046.44-53.562003-53.56

200455.5210044.48-55.522004-55.52

199619971998199920002001200220032004

26.2126.3142.6638.440.4250.9751.453.5655.52

Purchasing Power of the Peso

199626.2126.21-26.21

Purchasing PowerDollar/Peso Exchange Rate

199780.00%99.62%26.31-26.31

199873.00%61.44%42.66-42.66

199969.00%68.26%38.40-38.40

200066.00%64.84%40.42-40.42

200162.00%51.42%50.97-50.97

200260.00%50.99%51.40-51.40

200358.00%48.94%53.56-53.56

200457.00%47.21%55.52-55.52

Purchasing Power IndexDollar/Peso Exchange Rate Index

19971.001.00

19980.910.62

19990.860.69

20000.830.65

20010.780.52

20020.750.51

20030.730.49

20040.710.47

Sheet1

0

0

0

0

0

0

0

0

0

Sheet2

00

00

00

00

00

00

00

00

Purchasing Power

Dollar/Peso Exchange Rate

Sheet3

00

00

00

00

00

00

00

00

Purchasing Power Index

Dollar/Peso Exchange Rate Index

Sheet5

DSB to Current Account Receipts

DSB to Current Account ReceiptsDSB to GDPUnemployment Rate

199711.256.88.7

199811.537.8210.05

199913.898.79.8

200012.24811.2

200115.619.1111.1

200216.29.5511.4

200316.239.711.4

2004

Sheet5

000

000

000

000

000

000

000


DSB to GDP

Unemployment Rate

Sheet4

00

00

00

00

00

00

00


DSB to GDP

National Government Outstanding Debt

1000000

19971.351,350,574.00

19981.501,496,222.00

19991.781,775,356.00

20002.172,166,710.00

20012.382,384,917.00

20022.822,815,468.00

20033.363,355,108.00

2004

0

0

0

0

0

0

0

Unemployment Rate

19978.70%

199810.05%

19999.80%

200011.20%

200111.10%

200211.40%

200311.40%

2004

0

0

0

0

0

0

0

Tax Effort

199717%

199816%

199915%

200014%

200113%

200212%

2003

2004

0

0

0

0

0

0

Tax Effort

World Economic ForumGlobal Competitiveness ReportCorruption Index Ranking1 = Least Corrupt

2002: Rank out of 80 Countries2003: Rank out of 102 Countries

Chart2

55

3439

4345

6861

7788

7692

2002

2003

Sheet1

19961997199819992000200120022003

Philippines-31-34-33-33-36-48-61-66

Singapore-1-1-1-1-2-4-4-6

Malaysia-10-9-17-16-24-30-27-29

Thailand-14-18-21-30-30-33-31-32

Indonesia-31-15-31-37-43-64-67-72

Vietnam-49-39-48-52-60-65-60

Quality of National Business Environment Ranking

199819992000200120022003

Philippines-45-46-46-54-67-66

Singapore-6-12-5-9-5-4

Malaysia-26-31-30-37-26-24

Thailand-36-39-40-39-35-32

Indonesia-51-52-47-58-65-65

Vietnam-43-49-52-62-58-47

Corruption Index

20022003

Philippines7692

Singapore55

Malaysia3439

Thailand4345

Indonesia7788

Vietnam6861

20022003

Indonesia7788

Thailand4345

Singapore55

Philippines7692

Malaysia3439

Vietnam6861

20022003

Singapore55

Malaysia3439

Thailand4345

Vietnam6861

Indonesia7788

Pnilippines7692

Sheet1

-31-1-10-14-311996

-34-1-9-18-15-49

-33-1-17-21-31-39

-33-1-16-30-37-48

-36-2-24-30-43-52

-48-4-30-33-64-60

-61-4-27-31-67-65

-66-6-29-32-72-60

Philippines

Singapore

Malaysia

Thailand

Indonesia

Vietnam

Sheet2

-31

-34

-33

-33

-36

-48

-61

-66

Philippines

Sheet3

000000

000000

000000

000000

000000

000000

Philippines

Singapore

Malaysia

Thailand

Indonesia

Vietnam

0

0

0

0

0

0

Philippines

00

00

00

00

00

00

2002

2003

00

00

00

00

00

00

2002

2003

00

00

00

00

00

00

2002

2003

National BudgetBudget deficit 2004: US$5B or 35% of the national budget% of National Budget for debt servicing: 30%-45% (2002-04)

What Can NGOs and POs Do About the Situation?Advocacy Based StrategiesLocal Government Based Strategies Community Based Strategies

Advocacy Based Strategies #1Lobby for national policy coherence in health human resource development (HHRD). Lobby (text, write, email, call) the heads of the 15 government agencies involved in HHRD to regularly meet and speak with ONE voice.These are: DOH, DOLE, POEA, OWWA, CHED, PRC, PhilHealth, PITAHC, DOF, DFA, NEDA, DBM, TESDA, DOST, DTI

What NGOs & POs can do?ConvergencePartnershipBudget InvolvementMonitoring/quality standardCommunity Management/community basedPolicy involvementPolitical Reform/Good PoliticsPeople empowerment in governanceDevelopment of indigenous resourcesMore women leadersCommunity awareness/education for allHealth empowermentequity

The Extra Challenge

NGOs, POs and Communities Can Do It !!!!!!

Lets Do It NOW !!!!!

Thank You Very Much!!Maraming Salamat Po!Jaime Z. Galvez Tan M.D., [email protected]+63917 853 7798 mobile

199820031998200319982003LEGEND:Comparison in the Prevalence of Malnutrition Between 1998 and 2003 among 6-10 Year-Old Children 199820031998199820032003


Chart12

63.5

54.9

42

Year

Rate

Under-five Mortality Rate

Data1



1965234,93548,050186,88520.45%79.55%

1970234,03862,025172,01326.50%73.50%

1975271,13698,220172,91636.23%63.77%

1980298,00692,808205,19831.14%68.86%

1985334,663114,125220,53834.10%65.90%

1990313,890129,622184,26841.30%58.70%

1995324,737135,328189,40941.67%58.33%

2000366,931130,501236,43035.57%64.43%

2002396,297130,192266,10532.85%67.15%

Chart1

0.20452465580.7954753442

0.2650210650.734978935

0.36225362920.6377463708

0.31142997120.6885700288

0.34101469240.6589853076

0.41295358250.5870464175

0.41673107780.5832689222

0.3556554230.644344577

0.32852128580.6714787142

Year

Percent


Data2




Philippines396,297130,192266,10532.85%67.15%

NCR65,13035,96129,16955.21%44.79%

CAR5,5551,9743,58135.54%64.46%

I28,3227,44620,87626.29%73.71%

II14,4173,83110,58626.57%73.43%

III44,59413,04231,55229.25%70.75%

IVA49,78114,23435,54728.59%71.41%

IVB9,8212,8316,99028.83%71.17%

V25,7186,24819,47024.29%75.71%

VI38,40612,09226,31431.48%68.52%

VII33,6829,12624,55627.09%72.91%

VIII18,2274,46013,76724.47%75.53%

IX9,9932,9897,00429.91%70.09%

X14,8074,8109,99732.48%67.52%

XI16,3655,37110,99432.82%67.18%

XII10,5572,7527,80526.07%73.93%

XIII8,1232,2865,83728.14%71.86%

ARMM2,7997392,06026.40%73.60%

Chart2

0.4478581299

0.6446444644

0.7370948379

0.73427204

0.7075391308

0.7140676162

0.7117401487

0.7570573139

0.6851533615

0.7290540942

0.7553080595

0.7008906234

0.6751536435

0.6717995723

0.7393198825

0.7185768805

0.7359771347

REGION

Percent


Data2a




Philippines396,297130,192266,10532.85%67.15%

NCR65,13035,96129,16955.21%44.79%

CAR5,5551,9743,58135.54%64.46%

Region I - Ilocos28,3227,44620,87626.29%73.71%





Region V - Bicol25,7186,24819,47024.29%75.71%









ARMM2,7997392,06026.40%73.60%

Data3


Year%

199328.2

199834.2

200359.8


Year%

199371.5

199865.5

200361.4


Age199319982003

Date post:	28-Dec-2015
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The Philippine Health Care System: An Update Jaime Z. Galvez Tan, MD, MPH jjjj zzzz gggg aaaa llll...

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