UHC 21: The PGH, Manila City Government and Civil Society

An official of the University of the Philippines (UP) Manila, where the College of Medicine and the Philippine General Hospital (PGH) is based, Dr. Tony Leachon who is also a friend, posted in his facebook wall about the need to raise the budget of the PGH.

This year, the UP System (UPS) total budget is P9.53 billion of which P2 billion goes to PGH alone. Next year, UPS total budget will be P8.1 billion, and again, P2 billion of which will go to PGH alone. This year too, UPS’ capital outlay (CO) is P1.45 billion but zero for next year.

(See http://www.dbm.gov.ph/wp.../uploads/NEP2014/VIII/VIII.pdf)

Those in UP Manila estimate that PGH needs P4 billion a year to run smoothly, a “Harvard like institution” and at least P1 billion is for CO alone to improve or replace many of its dilapidated facilities.  

There are two moves being proposed. One is to double PGH annual budget and two, PGH should have a separate budget from UPS budget.

I suggested that there should be similar effort to pressure the Manila City government to contribute to PGH regular funding. I think it is safe to assume that about one-fifth of PGH’s patients, confined and outpatient, are residents of Manila City.

The City of Manila government does not feel it has any responsibility over PGH funding as it also finances about six city-owned hospitals, like Ospital ng Maynila , Ospital ng Sampaloc, Tondo General Hospital, Sta. Ana Hospital.

This is not correct. The city government has "no responsibility" but "has privilege" or "has right" to use PGH for its residents. Right without responsibility is a good formula for free riding and citizen irresponsibility.

A better option for the city government would be to sell or privatize one or two of its six (?) city hospitals, get the money and contribute to PGH regular funding.

This practice by national government agencies to subsidize Manila-based facilities and give Manila-based residents various subsidized or free services contribute to more congestion of Metro Manila. People in the Visayas, Mindanao, Bicol or Ilocos regions have no PGH but they contribute to the annual budget of PGH. They do not have MRT or LRT but they contribute to the annual subsidy of LRT and MRT. So many people from the provinces jump to Manila, partly to enjoy these freebies that are not available in their provinces and cities.

If the Manila City government will not contribute to PGH funding, PGH should NOT get budget increase from Congress. Instead, Congress-appropriated budgetary hike for healthcare should go to existing big DOH hospitals in Mindanao, Cebu or Iloilo, Bicol, Ilocos, Cagayan regions. Make these region-based hospitals become more modern, in infrastructure and health professionals’ training and specialized services. This way, the old practice of national agencies (UP, DOH) favoring Manila-based residents and contribute to further Manila congestion will be corrected.

Someone suggested that my above proposal does not and should not apply because of health insurance portability principle, that national taxes should apply to everyone. If we are to follow this logic, then it should be fine to have 3 or 5 more PGH in Manila City alone, and if funds for healthcare in other cities and provinces are not sufficient, public hospitals there can be closed down, anyway the people can go to the many PGH system in the city of Manila alone.

Any increase in public health should go to one regional or big island hospital -- in the Visayas, Mindanao, Bicol, Ilocos, or Cagayan region. Any significant increase in PGH funding should come from the Manila City government and from private donation, what Atty. JB Baylon is doing to raise funds for the PGH Medical Foundation through the "I am a Person Giving Hope (PGH)" campaign. Many showbiz, basketball stars and corporate individuals are supporting this cool initiative.

There should be more civil society and corporate involvement in increasing PGH funding, it should not rely on more national funding. Once again, the Manila City government must contribute to PGH annual funding as the hospital is serving many of its residents and voters.

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See also:

UHC 17: First, Second and Third Lines of UHC for the Poor, July 30, 2013 

UHC 18: DOH Budget, Healthcare Deregulation and PharmaWealth, August 08, 2013 

UHC 19: Health is a Right, Health is a Responsibility, September 19, 2013 

UHC 20: Health Equality Will Never Happen, September 20, 2013

EMHN 9: Private Sector Role in India UHC, April 10, 2013 

Generic Drugs 4: DOH Generics Summit 2013, October 04, 2013

Blood Donation 4: At the Philippine General Hospital

Below are my facebook notes today when I went to the Philippine General Hospital (PGH) to donate blood to a patient who has been at the intensive care unit (ICU) for a month now…

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Arrived at the hospital around 7:30am. Guard at the entrance won't allow me because I don't have written authorization letter from the patient or his/her guardian that I am donating blood. I said I don't have one because the notice to ask for blood donors was done only via facebook.

Anyway, I went to the 6th floor, patient's room. I was told to go to 2/F, ICU, the patient is there. I saw Rosalie at the ICU, my heart sank. The staff there gave me a form to give to the blood bank as my authorization letter.

At the blood bank, there were many donors in a small room, air con. I arrived there around 7:50am. Guard gave me the form to fill up, medical questionnaire to prove that donor is indeed in good health (no HIV, no malaria, no tatoo, no body piercing, no maintenance drugs, etc.). Then guard said, "Balik na lang po kayo 10am, next batch na po kayo"

Aray ko, paano trabaho ko, sabi ko sarili ko. Pero andito na ako, hintayin ko na, as I remember the sorry condition of the patient. I went out for breakfast, then to an internet shop.

I have donated blood 3x to 3 different patients before. At Makati Med, Asian Hospital in Alabang, and Medical City Ortigas. Donors are treated well in all of them -- clean, air-con, big rooms with cable TV, but few donors. Clean CR is just nearby. The staff there are very friendly and courteous, they told me they really lack blood donors, the hospital has to buy blood somewhere sometimes.

Went back to blood bank section at 10am as instructed, guard said it's only for further interview of our response to the questionnaire, the doctor that will take our BP, heart rate, check any suspicious physical problem, will come at 11am, ouch, then blood sample extraction. All these were finished by 11:30am. We were told to come back after 1 1/2 hours (ie, 1pm) as they will analyze our blood for any impurities (ie, free of HIV, malaria, dengue, whatever viruses/bacteria).

I just got out of PGH compound and crossed Taft to eat and walk around, when the incoming President of the PGH Medical Foundation, JB Baylon, called me. He was in his car and he's going to the PGH, what a coincidence. He asked me to hop in, I did. He brought me to the Foundation office, we talked about many things about public health, PGH, private giving, the Foundation, etc. Thanks for the lunch treat and the chat, JB.

Went back to blood bank around 1:30pm, only to see that those who came ahead of me have never been called yet for the final blood letting. Waited till 2pm, still nothing...

When situation gives you lemon, make a lemonade, so they say. So I walked around and toured the various wards of PGH -- pedia, orthopedic, neurosciences, trauma, etc. My first tour of the hospital actually, by myself. The air around the hospital rooms and corridors seems suspiciously unhealthy. I remember the issue of anti-microbial resistance (AMR) and hospital rooms as nests of new and evolving diseases themselves.

Went back to blood bank around 2:30pm, no one was called for half hour for the actual bloodletting. Many fellow blood donors waiting outside getting more bored, like me.

I went inside and asked what's going on. I saw 6 empty chairs, the staff inside were chatting among themselves, I saw a lady trying to selli bags to the staff.

I controlled my anger as I was told by Andy of the PGH Medical Foundation that the hospital has only one "centrifuge", a machine that tests blood samples for any impurities, which then will be the basis whether to accept or reject a prospective blood donor. That's one major reason why things are soooo slow at the blood bank.

The staff inside, instead of chatting among themselves, at least one of them should have gone out and explain to the waiting blood donors outside, why things are slow, why an ordinary blood donation would ruin practically their whole day's work, but none of that. One male staff, the one who got my blood sample, looked irritated why I asked them when will they call again blood donors so we can go home or go to work.

Later, a lady explained to me that they have to perform 8 different tests to each blood sample. Even if a sample passes 7 of those but fails in one test, a potential donor will be rejected. Sometimes they repeat the tests if they doubt the results. I think it is a valid explanation, but if I didn't ask, she will not explain it to me or to anyone among the donors.

Sensing my impatience, she asked me to sit on the reclined chair for the actual blood letting. Which took me only about 5-7 minutes to fill one bag. Then 15 minutes mandatory rest period.

Went inside the Blood Bank around 7:50am, finished everything by 3:20pm, 7 1/2 hours!

Health Spending 6: Health/GDP Ratio 2010

In my blog post the other day, On Inequality and Inclusive Business in HC, I wrote:

On government health spending, I think the ADB, WHO, UN, etc. data on PH public health spending is understated and wrong. They usually count only DOH + PhilHealth spending. They do not include some or all of other govt spending such as:

1. LGUs, with provincial and city health centers and hospitals. Manila City alone has six city-owned hospitals.
2. Philippine General Hospital (PGH), budget about P2 billion a year, part of the UP annual budget; hence, it is not counted as health spending but education spending…. 

This table is from the World Health Organization (WHO)  which I copied today. It says that the Philippines’ health spending / GDP ratio as of 2010 was only 3.6 percent.

Table 1. Philippines Basic Health Stats, from WHO 

  
source: http://www.who.int/countries/phl/en/

I posted the above observation (in italics) in the email loop among members of the Medicines Transparency Alliance (MeTA) Philippines, where an official of the WHO West Pacific Regional Office (WHO-WPRO), Ms. Klara Tisocki, is among the members.

Klara was kind enough to reply. She said, 

Regarding your comments  please note that WHO collects health expenditure related data in countries via the  national health accounts (NHA).  NHA constitute a systematic, comprehensive and consistent monitoring of resource flows in a country’s health system for a given period. NHAs use classification schemes, which are designed to be compatible with those practiced internationally; most importantly, the System of national accounts (SNA), to make cross-national comparisons possible.  

The International Classification for Health Accounts (ICHA) is a comprehensive system which classifies NHA into four dimensions: Financing sources (FS)-contributions by different actors; Financing agents (HF)-entities who manage health expenditures; Providers (HP)-entities that provide health care services and goods; and Functions (HC)-types of health care activities. You can read more about NHA at WHO webpage: http://www.who.int/nha/what/en/index.html  

More specifically  regarding the Philippines health expenditures these are collected via the Philippines National Health Account  (PNHA)  (which in turn reports to WHO for inclusion of Philippines data in WHO databases).   

The methodology and current statistics of PNHA are available on the website of  Philippines National Statistical Coordination Board  http://www.nscb.gov.ph/stats/pnha/.  

I would also like to refer you to the technical notes,  http://www.nscb.gov.ph/stats/pnha/technotes.asp on sources of data for the Philippines health financing, with regard to  your assumption that WHO, ADB, UN etc. count only DOH and Philhealth spending.  In these notes you will find the detailed description of Data Sources and Estimation Procedures as approved by NSCB Resolution No. 8 Series of 2011, that shows  what data  from which sources  are included under the different sectors and you can see the wide range of data sources considered.  

I thanked Klara for her reply as it provided useful links. From the NSCB link, here are the numbers:

Table 2. Philippines Health Expenditures by Sources of Funds

source:  http://www.nscb.gov.ph/stats/pnha/.