POLICY RECOMMENDATION

Healthcare Costs and the Burden of Disease

In 2005, total healthcare expenditure in the Philippines amounted to Php165 billion pesos, or about 3.5% of the GNP. Net of administrative costs, 10% was spent for public health while 80% was spent on personal health care services, majority of which has been for the treatment of diseases and their complications. Our healthcare spending has been focused on “sick care”, paying for products and services for patients to treat diseases when people have already developed them or are in the advanced stages, with expenditures escalating as more technology, medicine, professional fees and hospitalization costs are used in management. This is a highly inefficient way of using meager personal and government health resources, especially since it is well-established that much less resources are needed to prevent the onset of these diseases. To illustrate the urgent need as well as practicality of the preventive approach, it must be illustrated that, at present, the Philippine healthcare system is beset by the double burden communicable and non-communicable diseases which are potentially preventable given the proper education of the population.

         • While communicable diseases have decreased in the developed countries, 8 of the top 10 causes of            morbidity in the Philippines are still communicable. The diseases highlighted below, on affected persons can            spend thousands of pesos on a single hospitalization, are easily preventable with knowledge of            disease-causing mechanisms and readily available preventive measures such as vaccination and sanitation            control.

Last update: January 18, 2006

The Current Situation of Health Education
An examination of the Department of Education’s prescribed curriculum shows that in the elementary levels, health is taught only as a part of the English language curriculum from grades 1 to 3. The basic tenets of disease are taught beginning Grade 4 to Grade 7 only as a part of the entire Science curriculum. The Grade School health curriculum can therefore use some fresh modules on what the most common diseases are, what causes them and how to prevent them.

The high school health curriculum contains the basic elements of disease causation, and only recommendations on emphasis on the top causes of illness among children and adults may need to be inputted.
In the highly specialized curricula of tertiary education, health emphasis may be seen only in health-related professions. An alternative approach to teaching disease prevention and health promotion through awareness campaigns in colleges may be undertaken with the help of CHED in order not to compromise the curriculum of the respective college courses.

The Current Situation of Healthcare Professional Education and Human Health Resource

The exodus of healthcare workers remains a threat to future health human resources. Addressing the reasons for leaving will be a long-term and massive multi sectoral approach involving economic and political reforms.
It is the purpose of this recommendation to bring to fore an approach that is geared towards retaining healthcare graduates by instilling in them skills that will
     • enable them to understand the healthcare situation in the country and their role as future healthcare        practitioners
     • imbue in them a desire to effect change in the health system, in so doing hopefully encourage them to remain        in the country
     • equip them with basic managerial and leadership skills to rise up to the challenge of leading their communities        as respected healthcare professionals
     • make them more effective healthcare practitioners in the Philippines by matching their learning and curriculum        with the needs of the healthcare system today. Specifically, this involves a greater emphasis on public health        and preventive medicine which underlies most of the health concerns today.

The courses in most health education institutions at present may have these subjects in one form or another. It is our aim to create a multi-sectoral committee to discuss how all institutions can work together to unify the approach to teaching these critical skills to our students in medical, nursing and allied health professions.

The Benefits of Preventive Care through Education
With the easily-preventable nature of these diseases, health promotion and education may be a highly cost-effective program to reduce the burden of illness. Since majority of the morbidities involve children and young adults, an integration into the primary and secondary curriculum may be the most direct way to reach the population-at-risk. Meanwhile, the youth may also share this knowledge with their families to break the cycle of health risk by starting healthier practices that may prevent the development of the top mortality causes in their adulthood. A nationwide awareness campaign championed by the healthcare professions will also contribute to the elevation of knowledge, and hence expectations and standards for hygiene, sanitation and lifestyle among the populations at risk. Properly informed, all stakeholders will then be able to discern healthy from unhealthy practices and will be empowered to look after their own health. It is hoped that more and more Filipinos will become aware that it takes very little from every person to prevent a tremendous expense on disease (both out-of-pocket and government) and that preventive healthcare is very doable. As individual efforts on health will most often necessarily redound to positive effects on the community, the education and awareness approach which influences individuals primarily may prove to be the most efficient, practical, realistic and effective way to reduce the burden of disease in the Philippines.

Current approaches and interventions

A number of health promotion programs are currently being undertaken through private and government partnerships. A number of programs are being done by the affiliate medical societies : the Philippine Heart Association has partnered with the Department of Health in its “Mag-HL (healthy lifestyle) tayo program”; Community Health projects with the Vice-mayors’ League are also underway; the Philippine College of Chest Physicians is spearheading smoking cessation campaigns with a number of private organizations; the Philippine Pediatric Association has a School Health partnership extending medical check-ups to public schools. There is thus a big opportunity to focus all these efforts into one integrated cost-effective program targeting the very core of knowledge: the school systems from elementary to college.

A pilot program using the model of curriculum integration and health service enhancement has been implemented in the Philippine Science High School Western Visayas . In the program, modules were shared by the affiliate medical societies, studied and adapted by the school administrators and teachers, and cascaded to students and even parents. To enhance the appreciation of the importance of health, medical check-ups were also conducted by doctors for students and teachers. The acceptance of the program among the recipient students, teachers and parents was high, though the impact to actual health practices of the students and its subsequent effect on reduction of diseases in families has yet to be followed-up. This pilot program can serve as a model for more schools in the future.

POLICY STATEMENT

Recognizing the enormous burden of highly-preventable diseases on the Philippine healthcare system and on Filipino
families, and the potential effectiveness and efficiency of an educational and awareness campaign towards preventing them, it shall be the policy of the State to promote education and awareness on the prevention of the most common causes of morbidity and mortality among Filipinos through its integration into the health curriculum of primary, secondary and collegiate levels. This policy aims to achieve a reduction in the morbidity and mortality caused by communicable disease as documented by the Department of Health, and decrease in burden of such illnesses for the government and for the citizens by 2010.

It shall also be the policy of the State to ensure that health professionals receive adequate training on the Philippine healthcare system, its stakeholders, and its current condition with all the problems and opportunities, in order to inspire in these professionals a desire to contribute to the improvement of Philippine healthcare and equip them with the knowledge and skills to actually do so. It is hoped that by formally instituting this awareness campaign among the health professionals the State can appeal to the health students’ sense of nationalism and civic-orientation, and encourage them to do as much as they can with the knowledge provided to them to do more good for the country within their respective fields or as part of a healthcare professionals’ coalition.

Towards the implementation of these policies, the following programs are recommended:

1. Integration of modules on preventive healthcare for the top causes of morbidity and mortality into the curriculum of all private and public elementary schools, high schools and colleges in the Philippines. The key result areas will be the elevated knowledge of all teachers and students on preventive healthcare as shown by scores on examinations on the subject, and the yearly decrease in morbidity and mortality caused by communicable diseases in all regions as documented by Department of Health surveillance.

Key implementing agencies: Department of Education, Commission on Higher Education, Department of Science and Technology , the Philippine College of Physicians and the Philippine Medical Association and all affiliate medical societies, the Local Governments through their Health Units, and the Department of Health.

Project components:

Phase 1 : The Philippine College of Physicians (PCP) and its concerned affiliate societies will work with the Department of Education (Dep Ed) , Department of Science and Technology , and the Commission on Higher Education to integrate health education into the curriculum of elementary, grade school and high school. The PCP shall provide technical and scientific assistance in the development of modules for the top causes of morbidity and mortality in the country, ensuring the accuracy of the information and translating the scientific and medical concepts to language easily understood by non-medical people. The specialty societies can likewise recommend references or assist in the development of manuals to help teach these concepts. The Dep Ed , DOST , and CHED shall ensure that the modules are easily understood by students in each respective level, oversee the development of the teaching materials and examinations, and plan the cascade of the modules to all districts in the Philippines. The Dep Ed, DOST, and CHED will also recommend the hours per month/ semester allotted to health education to balance the needs of the entire curriculum. This is expected to be completed in 3-4 months from the start of the program

Phase 2 : The actual teaching of the modules to teachers will be planned by the Dep Ed, DOST, and CHED. The PCP and affiliate societies’ local chapter members may be tapped to augment the training staff. The target date for the training of the teachers is in the summer of 2007.

Phase 3 : The PCP can assist in developing other educational and awareness materials such as manuals, posters and flyers for students and their families to help clarify concepts and provide further reinforcement to the lessons. The societies may also assist in looking for funding from private organizations to help in the endeavor.

Phase 4: Implementation of the teaching may begin during SY 2007-2008, with periodic evaluations by the DepEd, DOST, and CHED for the understanding of teachers and effectiveness of the cascade to students.

Other components of the project:
(1) WELLNESS CARE PROGRAM / SOCIAL RESPONSIBILITY PROJECTS
Aside from the education and teaching aspect of the program, during enrolment, the local chapters of the affiliate medical societies can provide health services for free to the students in their municipalities to jumpstart the health awareness campaign for the school year. The Philippine Pediatric Association can offer medical check-up and vaccination to the students , the Philippine Dental Association can be tapped to provide dental check-up and basic interventions , and Philippine Academy of Ophthalmologists can do visual acuity screening for the children. Likewise, the adult medical specialty societies and nursing organizations can be encouraged to provide health screening for teachers, especially for diseases associated with the top morbidity and mortality causes, such as hypertension, pulmonary tuberculosis, diabetes and cancer. The PCP and PMA can work together to come up with an integrated program to put all the public service and health awareness projects of affiliate societies.

2. Integration of modules on The Philippine Healthcare situation , Public and Preventive Health, Managerial and Leadership Skills, , Health Economics and Outcomes Research, and Ethics in Medicine in the curriculum of all Medical, Nursing and Allied Medical schools.

Towards this end, a task force composed of members from the Commission on Higher Education, the Deans of the Medical, Nursing and Allied Health Professions schools and their curriculum directors, the Presidents and Continuing Education Officers of Medical, Nursing and Allied health professions, as well as the relevant divisions of the Department of Health must be must be organized to look into the improvement of the curriculum. A Healthcare Professional Curriculum Summit must be convened to achieve the objectives of evaluating the current curriculum for relevance and adequacy in helping the students understand the Philippine Healthcare situation and their role as future professionals. The Task Force will aim to come up with a unified curriculum including all the relevant topics starting SY 2007-2008 to be taught starting in the first year of all health profession courses, and evaluated as a separate topic during the professional licensure examinations beginning 2011.