Tanggol Kalusugan Concept Paper

Concept Paper

Tanggol Kalusugan

August 9, 2004

Context:

Devolution of the health sector, limited population coverage of the National Health Insurance Program, and diminished powers of the Department of Health have created an environment that allowed a cartel in the pharmaceutical industry to emerge.

This has resulted in drug prices in the Philippines that are among the most expensive in the world. In a country where the poverty rate is 70%, and where 80% of health spending is out-of-pocket, the high cost of drugs have resulted in:

1. Delayed consultations by the sick until the illness is advanced, and harder and more expensive to treat

2. Slower and poorer control of diseases such as TB and malaria, due to unaffordability of drugs resulting in poor compliance

3. Increased economic burden of disease, where the cost of treatment and opportunity costs negate economic gains at the levels of the household and the nation, and setting back development efforts of government, civil society and donor agencies

4. Increased vulnerability of the poor and the informal sector to the financial risks posed by illness

Policy Environment

Devolution in the Philippines has fragmented the health sector into over 1,600 autonomous and largely unregulated Local Government Units (LGUs) running Local Health Offices which serve as the backbone of the health sector. The remaining roles of the Department of Health include the management of a number of national hospitals, regulation, and technical assistance to the LGUs. The Philippine Health Insurance Corporation (PHIC) is a government-owned corporation and covers some 30% of the population and aims to provide universal health insurance coverage by 2010. A Generics Act was passed in 1988, but physician compliance and enforcement have been weak.

Devolution created an institutional gap in the health sector. There no longer exists a government agency or civil society organization functioning as an effective watchdog organization in upholding the public’s interests in the health sector. DOH has regulatory functions but limited enforcement powers. PHIC currently prioritizes membership expansion.

Response:

There is an opportunity for civil society to fill this institutional gap by creating a program or institution called Tanggol Kalusugan. Tanggol Kalusugan can be the focal point for watchdog activities in drug prices and other health-related public interests. As the focal point, it will fill in the organizational gaps within the network, thereby unleashing the full potential of the network affiliates, partners and allies.

Tanggol Kalusugan Program will provide leadership in holding national and local government accountable for the public for the public’s health concerns. Tanggol Kalusugan”s the first program aims to reduce drug prices, thereby making drugs more affordable, reducing the burden of disease on households, resulting in improved health, reduced health care costs, and improved quality of health care services for the poor.

1. Policies –hold government accountable for the enforcement of health policies that positively affect the poor.

2. Practices – foster an ethic of political engagement among stakeholders and serve as the catalyst for politico-economic actions.

3. Ideas – assist in the promotion of rational drug use, and advance the use of communication technology as a tool for political and economic empowerment

4. Beliefs – push the idea that expensive drugs are an injustice inflicted upon the poor

The academe-based and research partners have the capacity and credibility to conduct rigorous research, fora, and dissemination of research findings among the stakeholders.

The People’s Organizations such as ZOTO help validate and legitimize the cause, and can be mobilized for political action.

Advocacy groups such as the Medical Action Group has the experience and capability in carrying on advocacy campaigns.

People’s organizaitons– participated in the discussions and analyses on how drug prices are a burden to the poor

Health NGOs – carried out the research and advocacy work, resulting in inputs into this program design. Will be key partners in providing technical leadership and advocacy in the Tanggol Kalusugan-ZZZ initiative

National Government Agencies – participated in fora, validating findings in research