The country's health status is best summarized in the progress towards the MDGs. While the Philippines is on target for most of its MDGs, it lags behind in terms of reducing the maternal mortality ratio (MMR). The decline in neonatal mortality has also been very slow, as neonatal deaths comprise the majority of infant deaths. The MMR and infant mortality rate (IMR) were still at 95 to 163 per 100,000 live births in 20106, and 25 per 1,000 live births in 2008 (National Statistics Office, 2008), as against the MDG targets of 52 and 19, respectively.
For communicable diseases, the target for the tuberculosis (TB) case detection rate has been met, while a total of 22 provinces were declared malaria-free in 2008. The prevalence of HIV and AIDS remains below one percent of total population, although the number of HIV cases has been increasing annually. As in previous years, most of the ten leading causes of morbidity in 2008 were communicable diseases; in contrast, the leading causes of mortality in the country have mainly been noncommunicable diseases. There is a wide variance in the outcomes and program performance of priority public health programs, due to demand side problems related to health care access especially by the poor, such as geographical barriers, financial constraints, and limited information on family health risks.
While it is urgent to address the slow progress in meeting MDGs, the health sector also needs to focus on the prevention and treatment of chronic and degenerative diseases and traumatic injuries, which are now the fourth leading cause of mortality. Many such deaths are untimely and financially catastrophic, affecting mostly the working-age population and causing large intergenerational effects.
In health care financing, the 2007 Philippine National Health Accounts (PNHA) revealed that 54 percent of the total health expenditure comprised out-of-pocket expenses, and only 9 percent from social health insurance. Total health expenditure was only PhP234.3 billion, or 3.2 percent of the GDP, which is below the World Health Organization's (WHO) benchmark of 5 percent of GDP for developing countries.
High out-of-pocket expenses and low prepayment schemes reflect an unevenness, if not an inequity, in health care financing. The results of the Benefit Delivery Review by the Department of Health (DOH) and Philippine Health Insurance Corporation (PHIC) highlighted the need for PHIC to increase its enrolment coverage, improve the availment of its benefits and increase the support value for its claims, for the National Health Insurance Program (NHIP) to provide Filipinos with financial risk protection. Moreover, benefit delivery for the sponsored program is lowest among member groups. To date, the nationwide benefit delivery ratio (BDR)7 is only 8 percent (Annex 8.6).
Public hospitals and primary health facilities cannot provide adequate services and quality care. Recent data show that only 977 out of 1,073 of DOH-licensed private hospitals (91%) and 631 out of 711 of DOH-licensed government hospitals (88%) are accredited by PHIC. These ratios are expected to decline once PhilHealth raises accreditation standards to globally competitive levels. The deterioration and poor quality of many government health facilities, which is particularly disadvantageous to the poor, is due to: (a) backlogs in upgrading of existing facilities, including those required to make public hospitals safe from disasters; and (b) the inability of the total capacity of public health facilities to meet demands from an increasing population base.
While the Philippines produces a globally-competitive medical and allied health workforce, many parts of the country, especially far-flung and depressed areas, remain underserved. Human resources in the health sector are concentrated in urban areas, with fast staff turnover and oversupply of personnel.
On nutrition, underweight, stunting, wasting and thinness continue to be serious problems. The proportion of underweight children under-five decreased from 27.3 percent in 1990 to 20.6 percent in 2008, or an average annual percentage point reduction of 0.352. However, this is only 67.2 percent of the desired rate of decline to achieve the MDG of 13.7 percent. In addition, stunting8 among under-fives (32.2%) and wasting9 (7.5%) are at high levels. Thinness is also prevalent among school-age children (8.1%). About 26.3 percent of pregnant women are nutritionally at-risk, with low weight-for-height levels.
Overweight and obesity is prevalent among adults, at 26.6 percent based on the National Nutrition Survey of 2008 (Annex 8.7). The prevalence of overweight and obesity among children less than five years old has increased three-fold between 1990 (1.1%) and 2008 (3.5%). Among children aged 6-10 years old, overweight and obesity increased from 0.1 percent to 1.1 percent in 2008 (based on International Reference Standards).
Micronutrient deficiencies continue to be a public health concern, especially among young children and pregnant women. About 15.2 percent of children 6 months to 5 years old were vitamin A-deficient (Food and Nutrition Research Institute, 2008). Iron deficiency anemia among various groups remains very high (based on WHO classification), specifically among infants 6-11 months old (55.7%); children 12-23 months old (41.0%); and pregnant women (42.5%). Iodine deficiency is another public health problem among pregnant and lactating women, with the average of 105 ug/L median urinary iodine excretion not reaching the WHO-recommended level of 150 ug/L.
Hunger is another serious concern. While the percentage of Filipino households with inadequate caloric intake decreased from 69.4 percent in 1990 to 66.9 percent in 2008, quarterly surveys on hunger by the Social Weather Stations (SWS) since 1998 showed that the hunger situation has been volatile within a year, characterized by spikes and dips. However, the subsistence incidence10 of families decreased from 8.7 percent in 2006 to 7.9 percent in 2009, or from 11.7 percent of the population in 2006 to 10.8 percent in 2009.
The current population growth rate (PGR) of 2.04 percent remains high and means 1.8 million Filipinos are added every year. At this rate, the population will double in 34 years. This has also contributed to the high dependency ratio of 69 percent as of 2000, with a youth dependency ratio at 62.6 percent and an elderly dependency ratio of 6.5 percent. This means that every 100 persons in the working age group (15-64 years) have to support about 63 young dependents and about six elderly dependents. Dependency reduces growth in savings and funds for investment in productive capacity. In turn, underinvestment reduces overall economic growth and prospects for poverty reduction.11
The actual fertility rate of 3.3 children is one child higher than the desired fertility rate of 2.4. The biggest difference between actual and wanted fertility is most evident among women with lower education achievement and incomes. Based on the 2008 National Demographic and Health Survey (NDHS), the country's contraceptive prevalence rate (CPR) was only 51 percent. It is a source of concern that the level of unmet need has increased from 17 percent in 2003 to 22 percent in 2008.
Although the DOH has continued to implement reforms, more effective mechanisms are needed to further enhance the health system. Areas needing improvements include health financing in local health facilities and medical centers, and preventive measures to reduce noncommunicable diseases, such as diabetes mellitus, hypertension and trauma. Moreover, the health information system, including research, should be strengthened, in order to ensure that policies and programs are based on evidence and limited resources are used effectively and efficiently.
______________________________________________________________________________
6 NSCB Resolution No. 11, Series of 2010 - Adopting the Interim Estimation Methodology Used in Generating National-Level Estimates of Maternal Mortality Ratios for 1990 and 2000-2010.
7 BDR refers to the cumulative likelihood that any Filipino is (a) eligible to claim; (b) aware of entitlements and is able to access and avail of health services from accredited providers; and (c) is fully reimbursed by PHIC as far as total health care expenditures are concerned.
8 Stunting is an indication of prolonged deprivation of food and frequent bouts of infections.
9 Wasting is an indication of lack of food or infection in the immediate past.
10 Subsistence incidence refers to the proportion of families (or population) with per capita income less than the per capita food threshold to the total number of families (population). (NSCB)
11 See "The Population-Poverty Nexus" by Balisacan, Mapa & Tubianosa, 2004.