Thursday, March 08, 2012

Health Transparency 5: Forum on Good Governance in Health

Government (local and national) procurement of medicines, medical equipment and other supplies, hiring of health professionals and consultants, are among the problematic and not-so-inspiring stories in the country.

During the MeTA 2nd National Forum in late January 2009 that I attended, I observed and posted this:'

.... Second, medicine storage and warehousing by local governments for their constituents. A presenter from the WB showed some of his findings, complete with pictures: dirty warehouses, rodents, garbage and medicines mix up in one room. Warehouse personnel who do not make a regular inventory of medicines, how many have been disposed, how many are left, how many and what drugs are expired. Warehouses that do not have temperature control; one warehouse has a thermometer, fine, but the room temperature is several degrees hotter than the required minimum temperature for proper storage of some medicines. Some local health personnel release and give away expired drugs.
My proposal on this is that those warehouses by local government units (LGUs) should be closed down, LGUs can issue vouchers to their poor and needy constituents, the latter will go to government-accredited Botika ng Bayan or Botika ng Barangay to get the medicines, and the LGUs will pay those drug outlets later. There will be no need for LGUs and DOH then to train personnel for medicine procurement, warehousing, storage and inventory as internally proposed (using WB loans or additional budget appropriations) as these skills are already available in those government-accredited drug outlets. The comparative advantage of LGUs is politics and more politics, not efficient health care provision....
See, Health Transparency 1: MeTA Forum January 2009, January 26, 2009.

I actually expected the WB to demand major reforms in LGU procurement of medicines as the WB is a major lender to the government's health programs. But until now, I did not see or hear the WB, or ADB and other multilaterals, or the Department of Interior and Local Government (DILG), installing strict checking mechanisms to prevent the above wastes.

Ensuring good governance in health is an important and continuing challenge for the DOH and LGUs. Of course my personal policy bias is towards less governance in health, to assign more personal and parental/guardian responsibilities in healthcare to focus more on preventive than curative healthcare. But I digress.

This coming March 26, 2012, two big centers at the Asian Institute of Management (AIM), the Dr. Stephen Zuellig Center for Asian Business Transformation and the Hills Program on Governance will jointly sponsor the Good Governance in  Health forum. This is what the organizers wanted to achieve:

The key to providing concrete solutions against corruption is to maintain a consultative and cooperative relationship between stakeholder representatives and the government. This involves building stronger ties between health regulatory agencies and institutions concerned with fighting corruption and promoting good governance.
Following the mapping exercise on corruption cases and ethical dilemmas present in the delivery of health services in the Philippines, the second phase of the GGH program will involve the formulation of solutions and gathering of best practices in response to the identified cases. These solutions will be translated to the health sector through an extensive advocacy campaign, which includes capability-building workshops directed toward the promotion of anti-corruption practices and good governance in the Philippine health sector.
Representatives and key players from five sectors were targeted to participate: (a) local governments, (b) health regulators, (c) social health insurance, (d) commercial enterprises, and (e) medical practitioners.

I'm sure other sectors and players, like the huge health NGO community, will get jealous why they will not be invited  in this activity. But the organizers are facing a budget constraint and can accommodate only a limited number of participants. It is a by-invitation only event and not open to the public.

Former National Treasurer and former UP NCPAG Dean Leonor "Liling" Briones will be one of the few speakers. The bulk of the activity will be the workshop among the participants.

I remember there was one meeting by MeTA Philippines, about the result of the WB-funded assessment of government procurement of medicines for selected hospitals (LGUs, DOH-affiliated, and the AFP hospital). Some of the figures presented were harrowing, as some government hospitals have procured at 10x or higher the given drug reference price. So if people think that central procurement by government of medicines and other medical supplies will result in lowering of prices, think again, it can be the opposite. The corruption culture in the government is still alive and kicking and so, cost maxmization instead of minimization, is what usually happens. The thieves and corrupt officials in various agencies will have little leeway to siphon off money to their pockets if they will procure at low prices, so the tendency to bloat the prices of procured medicines and/or other medical supplies.

Promulgating the rule of law -- the law against stealing and robbery in government and putting guilty parties to prison -- is the main solution to this and related problems. But this is easier said than done. So I hope that certain solutions and check-balance mechanisms that are more easily implemented, can be extracted from among the participants in this forthcoming forum.

See also:
Health Transparency 1: MeTA Forum January 2009, January 26, 2009
Health Transparency 2: CHAT Discussion and Debates, June 15, 2009
Health Transparency 3: MeTA Forum January 2010 (Prevention vs. Medication), January 27, 2010
Health Transparency 4: Drug Promotions and Government, September 03, 2010

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