A hopeful future
By Alberto Romualdez, M.D.
12 May 2010
FROM the very start of the electoral process, long before the official campaign period began, it was clear to almost all observers that whatever happened last Monday, its immediate repercussions would be critical to how the Philippines will fare in the coming decade and perhaps in the rest of the 21st century.
The elections have been held and all indications are that, in the case of the national leadership (with the possible exception of the vice-presidency and the last few senatorial slots which up to this writing appear to be still too close to call), the Filipino people have clearly and unequivocally spoken. The new president of the Philippines, elected by more than 40 percent of voters, will have as close to a national mandate as is possible given our still defective political process.
Election Day ended with much less than the expected violence. The new, and hitherto untested, automated system was carried out without major glitches in nearly all places. With most of the results generally credible and acceptable, the Comelec and everyone else connected with the polls deserve congratulations and a salute from all Filipinos. Any and all past errors of commission or omission should be forgiven and forgotten for the time-being until it is time to think again about the next polls and the need to do better next time by learning from these errors.
The automated elections also gave welcome relief to the unsung heroes of all Philippine elections – the teachers who have suffered through all elections past. More than any other segment of Philippine society, they have been the glue that kept us together. Still, even after their scintillating performance this week, their work is not yet done. This is because, just like the rest of the country, the work of putting the pieces of the national community together again is just beginning.
In the health sector, there are encouraging signs that its various components are close to agreement on the need to pull together to achieve universal health care in as short a period of time as possible. The strong electoral mandate accorded to the new national leadership will hopefully endow the Department of Health and other national government agencies crucial to health with the political will necessary to lead local governments, the private health sector, civil society, and communities to the common goal of health for all Filipinos - including the marginalized poor majority.
It appears that the efforts of universal health care advocates are bearing fruit among health provider groups, especially physicians who are arguably the most influential professional group in the sector. Before the elections, general practitioners and family physicians had begun discussions on their roles in a reformed health service delivery system. Specialists groups such as internists and others are coming around to reviewing the ways in which they care for patients to improve their contributions to this effort.
Last week, a historic meeting took place between the Philippine Obstetrical and Gynecological Society and the Integrated Midwives Association of the Philippines (including the government midwifery group). Together with Department of Health maternal and child health program specialists, the Professional Regulatory Commission’s Midwifery Board, and other advocates of reproductive health, the two groups affirmed a commitment to join in a united effort to achieve all the Millennium Development Goals – including the hitherto deemed unattainable reduction of maternal mortality nationally.
The Philippine Medical Association, until now considered a bastion of conservative free-market thinking in health, recently agreed to join in the movement for universal health care. For its 103rd Annual Convention on 19 May 2010, it has selected the theme: "Manggagamot, Mamamayan at Pamahalaan, Nagkakaisa sa Kalusugan" (Physicians, Citizens, and People – United for Health). This broad acknowledgment of the need for cooperation in health is a good omen for any government’s plans for improving the health status of the country.
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Even as the country is in the mood to pull together behind its new leadership, there remain a number of thorny divisive issues that could derail progress towards a more rational society that can accommodate diversity. Reproductive health and family planning together constitute one such issue.
In this regard, it is hoped that the new administration will now consider people’s needs as a priority over political expediency. Overwhelming evidence on health status indicators show that a sincerely pro-poor health policy cannot be implemented in the absence of a strong and aggressive program of delivering reproductive health services to all socio-economic groups.
A population growth rate of 2 percent where the bulk of the expansion occurs among the poorest half of the population is simply incompatible with equitable health development. Without national government commitment to assisting families to limit their size and space pregnancies, poor mothers and children will continue to suffer unacceptable levels of morbidity and mortality.
As a reminder to the incoming administration, an excerpt from a recent column is thus reprinted below:
"The first health sector casualty (of the Arroyo administration) was an ambitious family planning program designed to significantly reduce fertility rates and population growth rate even as foreign support for the provision of free contraceptives was scheduled to wind down. Despite some reassuring utterances from Mrs. Arroyo at the First Asia Conference on Reproductive Health in February 2001, it was clear that her dependence on the political support of the conservative Catholic hierarchy would not allow her the luxury of pursuing the pro-poor program of her predecessor. To begin with, the accomplished but unsigned purchase order for the first Philippine government funded importation of contraceptives was set aside. Soon thereafter, the newly appointed Secretary of Health rescinded the registration of a preparation of levonorgestrel, branded Postinor and intended as a ‘morning after’ contraceptive pill. Thus, in the first year of the Arroyo regime, reproductive health advocates were on notice that any rational program of family planning, responsible parenthood, women’s rights to free choice, or population management would face rough sailing for the following decade.
The persistently large family sizes among the lowest income groups in the Philippines contributed to the increasingly difficult management impediments of public health programs especially for vulnerable groups like mothers and children. For this reason, despite gains in such programs as tuberculosis control, immunization, and even nutrition, the early decline in morbidities soon slackened and most of the health-related millennium development goals are now unlikely to be achieved by the target year of 2015."
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